Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Ebola forces us to rethink how we document in the EMR

John Halamka, MD
Tech
October 26, 2014
59 Shares
Share
Tweet
Share

Over the past several years I’ve written about the inadequate state of clinical documentation, which is largely unchanged since the days of Osler, (except for a bit more structure introduced by Larry Weed in the 1970s) and was created for billing/legal purposes not for care coordination.

One of the most frequent complaints in my email box these days is a sense that the current record is filled with data, but little knowledge and wisdom.  It’s hard to understand each patient’s individual story.   Notes are filled with cutting/pasting, inaccuracies, and redundancy.   Sometimes among the dozen notes written each day by the medical student, resident, fellow, attending, and consultants there is inconsistency.

The era of Ebola has accelerated the urgency for us to rethink the way we document.

In recent lectures, I’ve called on the country to adopt Wikipedia and Facebook for clinical documentation.

I don’t really mean that we should use those products, but we should embrace their principles.

Imagine if the team at Texas Health Presbyterian jointly authored a single note each day, forcing them to read and consider all the observations made by each clinician involved in a patient’s care. There would be no cut/paste, multiple eyes would confirm the facts, and redundancy would be eliminated.   As team members jointly crafted a common set of observations and a single care plan, the note would evolve into a refined consensus.   There would be a single daily narrative that told the patient story.     The accountable attending (there must be someone named as the team captain for treatment) would sign the jointly authored “Wikipedia” entry, attesting that is accurate and applying a time/date stamp for it to be added to the legal record.

After that note is authored each day, there will be key events: lab results, variation in vital signs, new patient/family care preferences, decision support alerts/reminders, and changes in condition.

Those will appear on the “Facebook” wall for each patient each day, showing the salient issues that occurred after the jointly authored note was signed.

With such an approach, every member of the Texas care team would have known that the patient traveled to Dallas from West Africa. Every member of the care team would understand the alerts/reminders that appeared when CDC or hospital guidelines evolved.   Everyone would know the protocols for isolation and adhere to them.    Of course, the patient would be a part of the “Wikipedia” and “Facebook” process, adding their own entries in real time.

Yes, there are regulations from CMS enforcing the integrity of the medical record.  I’ve had preliminary discussions with folks in government who have signaled that as long as the “Wikipedia” authorship takes place outside of the medical record and then is posted/signed/timed/dated by a single accountable clinician, regulatory requirements will be met.  Once posted, the entry cannot be edited/changed, just amended, preserving data integrity.

It’s likely that the “Facebook” portion of the display would not be regulated,  but would require the same kind of validation we already do for lab result workflow.   The “wall” could also be certified for the meaningful use provisions that require viewing of the meaningful use common data set.

Once there is a single place for all care team members to look when treating a patient, decision support based on analysis of structured and unstructured data will be easier to engineer.

Although I believe that the medical record coding we do today will become less relevant as we evolve from fee for service medicine to global capitated risk, the use of computer assisted coding and clinical documentation improvement tools will be easier with the “Wikipedia” plus “Facebook” approach.

I can even imagine that emerging Fast Healthcare Interoperability Resources (FHIR) work could represent the “Wikipedia” entry as part of document retrieval standards and the Facebook wall could be part of discrete data query/response, providing a timeline for the key events in a patient’s treatment.  I’ve already discussed the need for such timeline data with key FHIR architects.

A team at Beth Israel Deaconess Medical Center is working on clinical documentation, structured and unstructured, in FY15. We’ll proceed incrementally, learning from each phase, and begin our journey toward an inpatient record that looks more like Wikipedia and Facebook than Osler’s notebook.    As Ebola and the tide of EHR dissatisfaction drive innovative documentation thinking, we’ll need to move deliberatively.

And if we’re lucky, care team members will rekindle the spirit of working and talking together instead of starting at a screen, checking boxes for meaningful use.

John Halamka is chief information officer, Beth Israel Deaconess Medical Center, Boston, MA, and blogs at Life as a Healthcare CIO.

Prev

Ebola presents a new paradigm from the ER

October 26, 2014 Kevin 3
…
Next

Ebola causes a crisis of commitment in physicians

October 27, 2014 Kevin 2
…

Tagged as: Facebook, Health IT, Infectious Disease

Post navigation

< Previous Post
Ebola presents a new paradigm from the ER
Next Post >
Ebola causes a crisis of commitment in physicians

More by John Halamka, MD

  • The future of EHR: Here are 5 predictions

    John Halamka, MD
  • 10 crucial guidelines for health care IT

    John Halamka, MD
  • 5 health care IT tips for President Trump

    John Halamka, MD

More in Tech

  • AI is living up to its promise as a tool for radiology

    Hoag Memorial Hospital Presbyterian
  • I’m tired of being a distracted doctor

    Shiv Rao, MD
  • AI-driven diagnostics and beyond

    Michael Kirsch, MD
  • The need for adaptability is imperative in the era of artificial intelligence

    Harvey Castro, MD, MBA
  • Harnessing the power of gamification in mental health apps

    Carter Do and Thomas Pak, MD, PhD
  • Leveraging ChatGPT’s high IQ to assist doctors

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions
    • Practicing medicine with conviction

      Arthur Lazarus, MD, MBA | Physician
    • The power of memory in shaping human identity

      Emily F. Peters and Sandeep Jauhar, MD, PhD | Physician
    • How Tratak yoga reshaped my USMLE Step 2 prep

      Dr. Nikita Mehdiratta | Education
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 10 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • FDA Relents, Approves Novel Antidepressant After Many Rejections
  • OSHA Comes in for Both Praise and Harsh Criticism at House Hearing
  • New Insight Into Hyperglycemia Risk With PI3K Inhibitor for Breast Cancer
  • Oktoberfest Doctor: Not the Wurst Job You Could Have
  • Blue Shield of California Has Fix for MA Enrollees Worried About Co-Pays

Meeting Coverage

  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Misinformed claims and the offensiveness of discrediting COVID-19 vaccine development

      Angel Garcia Otano, MD | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • Assertiveness in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Epigenetics and our inheritance to future generations

      Vishruth Nagam | Conditions
    • Practicing medicine with conviction

      Arthur Lazarus, MD, MBA | Physician
    • The power of memory in shaping human identity

      Emily F. Peters and Sandeep Jauhar, MD, PhD | Physician
    • How Tratak yoga reshaped my USMLE Step 2 prep

      Dr. Nikita Mehdiratta | Education
    • Transforming primary care for physician well-being [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Ebola forces us to rethink how we document in the EMR
10 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...