Figure 3.

Steps for generating the Breadcrumbs encounter summary. 1) Construction of the BES from metadata in log files. The original log file was compiled from metadata in the Clinical Audit Trail and UAL. Ten- second time markers and time spent in each EHR section were utilized to evaluate the continuity and significance of recorded interactions. Relevant EHR interactions were extracted into the action summary and integrated into the BES. 2) Mapping observed EHR interactions to those recorded in the log-file metadata. The screen tracking video was referenced to create the annotated log file, which described observable interactions that were linked to metadata in the original log file. Significant EHR interactions that were visible in the video were outlined in the gold standard visit summary, which was created by a physician who had viewed the video. 3) Comparison of E/M billing requirements satisfied by the log file and video. The billing requirements satisfied by the BES and the gold standard visit summary respectively were compared.