Wednesday, March 28, 2007

Disconnecting Input and Output

Before the Electronic Health Record, doctors scribbled incomprehensible code onto pieces of paper that wound up in a large manila folder on a shelf. These were called clinical notes. The doctors refer to these clinical notes to treat patients.

With the advent of the Electronic Health Record, doctors now enter their clinical notes in one of 3 ways:

- The stubborn ones continue to scribble incomprehensible code on pieces of paper - which are then scanned into the Electronic Health Record.

- More sophisticated users type their notes directly into the Electronic Health record. The ones who hate to type dictate their notes using a dictation service or voice recognition software. The transcriptions are then imported into the appropriate patient record.

- The most sophisticated users enter information into the Electronic Health record and have this information Auto-Cite into their notes. This reduces the amount of typing required and, if a doctor is really savvy, allows the doctor to request reports on their patient pool.

The problem with all of these inputs and the current generation of Electronic Medical Records is that there is a 1 to 1 relationship between input and output. You have to input separate clinic notes, patient letters, and provider letters. Oftentimes, the production of patient letters and provider letters is left to the administrative staff. For those working with docs of the stubborn variety - this means having to interpret the code....with occasionally interesting results.

The new version of the Electronic Medical Record I am working with has disconnected the input from the output. 1 to many.

What this means: I can enter the information on the clinic visit once (history, problems, medications, orders, assessment, plan, etc) and produce multiple outputs at the same time (a chart note, a letter to the referring provider, a letter to the patient, etc). These outputs can include or remove anything to suit the audience. The information is still available in the patient's record.

The level of complexity when setting this up is much higher. The amount of time it takes - much longer. The paybacks, though, will be worth it. Especially for the patients. Better tracking. More accurate information. Less guesswork.

So the next trick, after getting the docs through the pain of the upgrade, is getting them to work with us to build these notes.

To make matters even more interesting, the organization is going to force the docs to use this system to enter notes. I'm already seeing peer pressure between docs to stop the handwriting. There is also pressure from the administration to stop dictating.

Because these notes take so long to build - we are currently planning to stop developing custom notes for every doctor. Instead, they will have to work together to make a decision about their specialty's notes as a group. Doctors are independent beasts by nature. I have a feeling that politics will make our job much harder. This will be an interesting process.

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