  Purpose: This study evaluates the effect of Cydoc software tools on medical
note time-to-completion and quality.
  Methods: Medical students were recruited by email to participate in a video
encounter with a standardized patient for three scenarios: writing a note from
scratch (control), writing a note with the Cydoc educational tool, and writing
a note with the Cydoc intake form. Notes were subsequently anonymized and rated
by a resident physician across four quality measures. Note time-to-completion
was analyzed using a one-way ANOVA with post-hoc Bonferroni correction, while
note quality scores were compared using a Wilcoxon paired signed rank test.
  Results: Eighteen medical students participated in the study. The average
note time-to-completion, which included the patient interview and note writing,
was 17 +/- 7.0 minutes from scratch, 18 +/- 8.0 minutes with the educational
tool, and 5.7 +/- 3.0 minutes with the intake form. Using the Cydoc intake form
was significantly faster than writing from scratch (p = 0.0001) or using the
educational tool (p = 8 x 10-5). Notes written with Cydoc tools had higher note
comprehensiveness (3.24 > 3.06), pertinent positives (3.47 > 2.94), and
pertinent negatives (3.47 > 2.67), although this trend did not reach
statistical significance.
  Conclusions: Using the Cydoc smart patient intake form accelerated note
writing by 2.98x while maintaining note quality. The Cydoc smart patient intake
form has the potential to streamline clinical documentation and save
clinicians' time. Future work is needed to evaluate Cydoc tools in an in-person
outpatient setting with practicing clinician users.
