The research
PENCIL Health™ is built on one evidence-supported principle: patients benefit when clinicians explain the plan, put it in writing, and confirm it was understood.
The PENCIL Health™ workflow brings these three practices together:
A major analysis of more than 776 studies and about 75,000 patients found that patient education improved physical, physiological, psychological and functional outcomes across diabetes, cardiovascular disease, respiratory disease, cancer, musculoskeletal and mental health conditions. It was also associated with less pain, medication use and healthcare visits.
A Cochrane review of 19 randomized trials and 10,856 patients found small but measurable improvements in blood sugar, systolic blood pressure, depressive symptoms, self-efficacy and self-care. Benefits were greater when care planning was comprehensive, involved the patient’s usual clinician, and was part of routine care.
A systematic review of 18 randomized trials found low- to moderate-quality evidence that education improved medication adherence, most clearly in type 2 diabetes. The American Heart Association also lists patient education among the strategies that can support adherence, especially when it is individualized and repeated.
In a single-center study of 120 hospitalized adults, combining a written summary, physician-led verbal instruction and teach-back improved patient understanding in every major area:
21.5%
Diagnosis
35.1%
Treatment
45.8%
Medication changes
38.1%
Follow-up instructions
Gains in immediate understanding, not long-term outcomes.
Teach-back asks patients to explain the plan in their own words. It checks the explanation, not the patient. A systematic review found benefits in 19 of 20 teach-back studies, including understanding, knowledge, recall, self-management and quality of life, and in some studies, hospital readmissions. The optional Pencil Check supports this: patients review each step and confirm what they will do next.
A scoping review of 73 studies found reported benefits of after-visit summaries including better understanding, engagement, adherence, communication, care transitions and continuity of care. Patients valued them most when they were clear, personalized, written in plain language, focused on next steps, and easy to share with caregivers.
A 2026 study of more than 6.2 million visits at one large academic health system found the digital after-visit summary was not viewed after 62.4% of encounters, even though physicians spent a median of 1.38 minutes preparing the instructions. Patients engaged more when the instructions were personalized. This supports giving and reviewing the care plan during the visit.
PENCIL Care Plans use short sentences and plain language, at about a fourth- to fifth-grade reading level where possible: simpler words, not simpler medicine. The Agency for Healthcare Research and Quality notes that fourth- to sixth-grade reading levels are commonly recommended, and that readability scores alone do not guarantee understanding.
Each care plan breaks the plan into checkbox steps, so patients can see what to do and mark each step as it is discussed or done.
Every care plan follows the same P-E-N-C-I-L framework, whether it covers a condition, medication or procedure, so patients never have to learn a new format.
The medicine may change. The specialist may change. The PENCIL structure remains familiar.
Published research supports the individual practices the PENCIL Health™ model brings together, not the platform itself. Until the platform is studied directly, we will not claim it reduces readmissions, portal messages, healthcare costs or physician workload.