# From Pen to Portal: Using Artificial Intelligence to Evaluate the Impact of Electronic Patient Information and Communication (EPIC) on the Quality of Urology Clinic Letters at a Major London Hospital

## TL;DR

This study shows that using the EPIC electronic record system improved the quality and clarity of urology clinic letters at a London hospital.

## Contribution

The paper provides a novel evaluation of how EPIC impacts the structure and readability of urology outpatient letters.

## Key findings

- EPIC implementation led to shorter, more concise urology clinic letters with improved readability metrics.
- Global quality scores of letters increased significantly after EPIC introduction.
- Letters demonstrated clearer communication and better organisation following EPIC use.

## Abstract

Background

High-quality documentation is an essential part of providing patients with good clinical care. Clinical letters promote continuity, reduce errors, and communicate effectively between healthcare professionals. EPIC (Electronic Patient Information and Communication), an electronic patient record system introduced across several London hospitals, aims to improve the quality and consistency of documentation. There is limited evaluation of its impact on urology clinic letters.

Aims

The main aim of this is to evaluate the impact of EPIC implementation on the quality, structure, and readability of urology outpatient letters at King’s College Hospital, a major London teaching hospital.

Methods

A retrospective analysis compared consultant-authored urology clinic letters before and after EPIC introduction. The pre-EPIC dataset included 115 patients (119 letters, 2003-2023), and the post-EPIC dataset included 170 patients (209 letters, 2024-2025). Each letter was assessed for structure, language, and readability, using objective metrics, including word and sentence counts, syllables, and recognised readability indices. Quality was further assessed using the Sheffield Assessment Instrument for Letters (SAIL).

Results

Following EPIC implementation, letters were shorter and more concise, with lower character and syllable counts. Readability improved: Flesch-Kincaid grade level decreased from 8.7 to 7.9 (p < 0.001); Gunning Fog Index decreased from 12.1 to 11.4 (p = 0.017); and Coleman-Liau Index increased from 19.0 to 20.1 (p = 0.003), indicating simpler phrasing and clearer structure. SAIL analysis showed significantly higher global quality scores (7.5 vs 6.0; p < 0.01), and improved content validity, with letters demonstrating clearer communication and better organisation.

Conclusions

The introduction of EPIC produced measurable improvements in the clarity, structure, and overall quality of urology clinic letters. EPIC enhanced documentation consistency and supported clearer communication between clinicians and patients.