Sandbox Metrics

How to Make Note Templates That Clinical Providers Will Use

And What in Tarnation Does “Structured Data Index” Mean?!?

Posted October 20, 2022

We’ll get to the Structured Data Index in just a moment. But first the big picture on sandboxing note templates. This site is basically all about forms. As humans, we’re soaking in forms all day long. There are nice, simple ones that get the job done and their are also forms which will drive you to madness. So, if you’re making a form, it’s sometimes best to consider a few design elements as you are getting started:

1. Intended user and workflow
2. Scope
3. Layout
4. Calculations and decision trees
5. Structured data vs Free text
6. The Structured Data Index
7. The Answer is *maybe* Aim Low

#1 Intended user and workflow

If the template is intended for a clinical assistant gathering information for a primary care visit, the template may be general and standardized for a variety of visits. If it is intended for a surgeon performing an entire morning of cholecystectomies, it may be geared toward providing technical details of that specific procedure. It’s probably a good idea to get input from both the user who is working with the template as well as the consumers who will be reading and and trying to understand the output.

#2 Scope

Breadth and depth are the x and y axis for a note template and these variables drive the content of the note. It could be a single note template to handle all possible visits or one of many very specific templates to handle a variety of unique scenarios. If you’re starting out, it’s probably better to start out as general as possible and then spin off more specific templates as time goes on.

#3 Layout

The order and presentation of the content of the note template will be the script for the visit. Building in a solid history and exam that documents abnormal items as well as pertinent negatives is a good characteristic of a note template.

#4 Calculations and decision trees

Building in some decision support and thoroughly documenting all the considerations of a visit requires some thought beforehand. Similarly, calculations and decision trees draw from variables which must be entered earlier in the note. It’s helpful to map out the variables that will be needed for an interactive form with calculations and conditional statements (decision trees).

#5 Structured data vs Free text

Checklists, radio controls, drop down lists are good memory aids but they can slow down the visit, interrupt your train of thought, and generate unreadable notes. Administrators and billing departments favor these for coding visits and producing data for mining. But these are also very useful to practitioners who need data for calculators and decision tools.

Boilerplate and free text fields offer speed and flexibility but may result in a history, exam, and plan that are only marginally addressed. If clicks are speed bumps, providers can race through a note with boilerplate and free text.

#6 The Structured Data Index

The Structured Data Index and other Sandbox Metrics are new (as of October 2022) features made possible by small donations from users like you. If you want to know at a glance whether you’re making a template that looks perfect to you but will always stay up on the shelf and never be used you may get an idea by checking the Sandbox Metrics at the bottom of the template. If you have hunch you’ve created a rigid Frankenstein’s Monster of boilerplate out of a well-meaning intention to get home in time to play with your kids but you’re worried about destroying all of the hopes and dreams of your billing department, you could look down at the Sandbox Metrics below the result box of each template.

Each and every template at the SOAPnote Project has these descriptive metrics which include the number of each type of form element, the number of boilerplate words, the number of clicks, and the Structured Data Index. At a glance, you can see how things shape up.

Beyond that you get a snapshot of design elements of each template. Your users may prefer checklists to check boxes (they should, because it helps with pertinent negatives). They may not want a bunch of radio controls for layout reasons. And you may have people who feel as though every single click is like a tiny grain of their soul floating away to oblivion as they sit in front of the computer. You may want to limit the number of clicks for those people or provide them with a service animal or a massage chair. Most templates aren’t all clicks or all boilerplate, though. There’s a continuum from all mousework to all typing. That’s where the Structured Data Index comes in.

The Structured Data Index is not a grade, it’s a calculated metric. It’s a number from 0.000 to 1.000. Here’s how it is calculated: (total count of) date + checklist + checkbox + drop down + radio button)/(total count of textbox + text area + date + checklist + checkbox + drop down + radio button). If the Structured Data Index is 1.000, the note is entirely made of defined elements with choices (and lots of clicks). At that end of the continuum, there is no chance to sneak off the rails and enter free text. If the Structured Data Index is 0.000, the note has (not surprisingly) no structured data. That usually means fewer clicks, but might create output that is hard for a data scientist, finance office, or quality improvement officer to mine*.

#7 The Answer is *maybe* Aim Low

There are a lot of note templates on this site and some are more popular than others. We may be able to see a pattern in user preference by reviewing the notes viewed the most often in the past. So, here are the top 15 note templates for 2021 and their Structured Data Indices:

1. PHYSICAL EXAM + REVIEW OF SYSTEMS TEMPLATES 0.000
2. General Adult Physical Exams 0.050
3. Mental Status Examination 0.000
4. Female Exam 0.000
5. Sore Throat Complete Note 0.000
6. Health Maintenance Visit 0.050
7. Breast Exam 0.570
8. Pre-Op Clearance 0.000
9. General Pediatric Exams 0.010
10. Eye Exam 0.000
11. Knee Exam 0.000
12. Male Exam 0.000
13. Shoulder Exam 0.000
14. EMS DCHART (no longer published) 0.330
15. Otitis Media Exam 0.000

These 15 templates have a median value of 0.000, an average of 0.067, and a standard deviation of 0.163. So we can safely conclude that on this note template website in 2021, the most used note templates had very low Structured Data Indices. These templates have text box and text area elements and more free text than structured data.

In any event, maybe checking the Sandbox Metrics will you make better note templates no matter how much structured data or free text you impart them with. And ‘better’ hopefully means more usable with more human-appearing output. Good luck and drop us a line if you have questions or comments.

_{* Except for the fact that it’s the year 2022 and machine learning exists.}

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