It won’t be long before every patient has a Twitter feed, and doctors subscribe to them for real-time updates.
This is a time when the demands of being a physician are changing, and we need to leverage technology to maintain awareness of a huge number of patients. There is also increasing need for handoffs and communication between providers.
Here’s the bottom line: How can we improve technology when doctors seem so resistant? They are not happy with their EMRs, and rightly so, because they were built to do too much for too many.
The current system is inefficient
The EMR has become essential for documentation, billing, medical reasoning, and communication, among other things. Currently, documentation is built on a system of daily progress notes. If I consult a cardiologist about a case, he needs to go through each note, containing narratives, laboratory values, vital signs, and physical exams.
A patient with a seven-day hospital stay may have twenty notes that need synthesis to put together the story–this can take hours per patient!
In an age where more providers are involved in a patient’s care (whether due to duty hour restrictions, or the increasing presence of specialists for every problem), this inefficiency is not acceptable.
Providers hate redundant documentation
Not only is this system of documentation difficult for doctors to interpret, it is tedious to produce. Documentation has become a chore, and I’ll explain why. For patients in the hospital, documentation often exists in two separate streams, the daily progress notes (located in the official chart or the official EMR) and the summary/signout document (often located in a Word document on a hard drive in the hospital).
Billing and legal is based off the progress notes. The summary/signout document is often unofficial, developed from a need for a more up-to-date and comprehensive summary of what is happening with a patient. Think of it as a “final report,” synthesizing all the data, organizing ideas and describing the plan.
This also leads to poor communication
Because the workflow is built around the summary and signout document, daily progress notes have become ceremonial and rote. It therefore becomes unreliable—can I trust that the provider meant to check this box as normal?
Further, communication between providers suffers because the accessible document is often the progress note.
The solution comes from social media
That’s where the innovation of social media comes in. I see the major innovation of social media as of organizing the immense amounts of information. In the 90s you could join chat rooms about a particular interest or hobby.
On Twitter, you are participating in an infinite number of chatrooms at once, and you can be part of a conversation on #SXSW14 or @kevinmd just by searching.
Here’s how a Twitter-based EMR would work
All clinical data, events, notes, and annotations are included in a single live feed. This stream will serve as the centerpiece of all functions, with a few carefully designed filters.
With this conceptual framework, there are several natural improvements on the existing EMR.
- The clinical awareness view: By watching the raw live feed, you are immediately aware when your patient’s CT scan is complete or laboratory values are available.
- The patient timeline view: By looking at a patient’s feed, you can learn about the entire course of illness. It’s much faster that flipping through pages of notes that may have been copied forward.
- Progress note generation: Doctors and nurses need only focus on documenting in the Twitter feed. Progress notes are automatically produced from all the interval data.
- Conversation view: different specialists can have a discourse about a difficult case, and it’s built into the EMR. This is the meaning of patient-centered care.
In medicine we spend a tremendous amount of time and money on antiquated software that acts like a digital version of a paper chart. We can learn a few lessons from the innovators in social media about how to manage large amounts of data.