[The following clinician guest post is by Dr. Megan Ranney. Thanks Megan!]
Dr. Leslie
Kernisan’s recent blog post on “Zen and the Art of Charting” got me
thinking. I love her idea of a simple,
prioritized problem list to start out the chart… but worry that EHR developers
will focus on creating this for the primary care setting, to the detriment of “acute care providers.” I too often have to deal with EHR systems
that are created for office-based practices, and that don’t translate well to
the acute-care setting.
Kernisan’s recent blog post on “Zen and the Art of Charting” got me
thinking. I love her idea of a simple,
prioritized problem list to start out the chart… but worry that EHR developers
will focus on creating this for the primary care setting, to the detriment of “acute care providers.” I too often have to deal with EHR systems
that are created for office-based practices, and that don’t translate well to
the acute-care setting.
I am a practicing emergency physician, so I am
admittedly biased. Still, my day-to-day experience mirrors that of many
providers – whether emergency physicians, consultants, or urgent care center
docs. And one of my biggest day-to-day
frustrations is that I rarely know what patients’ PCPs are working them up for,
or what their concerns are about a patient, when trying to evaluate a patient’s
acute complaint.
admittedly biased. Still, my day-to-day experience mirrors that of many
providers – whether emergency physicians, consultants, or urgent care center
docs. And one of my biggest day-to-day
frustrations is that I rarely know what patients’ PCPs are working them up for,
or what their concerns are about a patient, when trying to evaluate a patient’s
acute complaint.
I know how much it means to my patients when I
can walk in the room already informed of their past couple visits. I would love to be able to do this easily,
for everyone. I do spend time (a lot of it!) on each shift trying to contact
PCPs to figure this out, so as to not duplicate care/waste resources. But my
phonecalls are inevitably returned while I’m in the middle of a procedure or
breaking bad news or trying to figure out a sexual history, and thereby end up
hurting patient care. Moreover, these
calls take the PCP away from their own job.
can walk in the room already informed of their past couple visits. I would love to be able to do this easily,
for everyone. I do spend time (a lot of it!) on each shift trying to contact
PCPs to figure this out, so as to not duplicate care/waste resources. But my
phonecalls are inevitably returned while I’m in the middle of a procedure or
breaking bad news or trying to figure out a sexual history, and thereby end up
hurting patient care. Moreover, these
calls take the PCP away from their own job.
Even if a patient has miraculously been seen
within my own hospital in the recent past (and therefore their record is
accessible at the time of their visit), I still have to do what Leslie mentions
— sift through months & years of inpatient and outpatient notes. I am therefore often in danger of missing the
most details that are most relevant to this ED visit, for even those patients
who should be most “protected” by an EHR.
No wonder EHRs haven’t been found to improve care.
within my own hospital in the recent past (and therefore their record is
accessible at the time of their visit), I still have to do what Leslie mentions
— sift through months & years of inpatient and outpatient notes. I am therefore often in danger of missing the
most details that are most relevant to this ED visit, for even those patients
who should be most “protected” by an EHR.
No wonder EHRs haven’t been found to improve care.
It goes without saying that my history,
physical, test-ordering, and differential diagnoses will be quicker, sharper,
and more accurate if I am fully informed of the latest and biggest issues “as
per the PCP.” If I could see Leslie’s
list that the depression hasn’t been addressed yet, or that the incontinence is
a longstanding issue, it would help me to focus in on the mental health
symptoms, or avoid the costly spine MRI …. Vice versa, if I can quickly
identify that the patient is being followed for an as-yet unruptured abdominal
aneurysm, I may rethink my diagnostic plan for a patient with belly pain, and
expedite a CT scan or ultrasound prior to labwork, thereby saving a life.
This is PARTICULARLY important for the
geriatric population who (unless they’re particularly empowered and mentally
sharp) may not have any recollection of their recent medical history. But honestly, it’s important for
everyone.
geriatric population who (unless they’re particularly empowered and mentally
sharp) may not have any recollection of their recent medical history. But honestly, it’s important for
everyone.
So please, EHR developers: create problem lists that are transportable
and interpretable by ALL care givers, not just the PCP.
and interpretable by ALL care givers, not just the PCP.
If we are truly going to create medical homes
for each patient – and if the EHR is going to be the vehicle to bring all the
information back to the medical home – the dialogue has to go both ways. If you can keep me, the emergency physician,
better informed, then I can do a more efficient, more caring, and more accurate
job in caring for the patient.
for each patient – and if the EHR is going to be the vehicle to bring all the
information back to the medical home – the dialogue has to go both ways. If you can keep me, the emergency physician,
better informed, then I can do a more efficient, more caring, and more accurate
job in caring for the patient.
(And, better yet, do research on whether or not
this works to improve care! Of course, that’s a topic for another post…)
this works to improve care! Of course, that’s a topic for another post…)
Megan L. Ranney, MD MPH, is an Assistant Professor in the Department of Emergency Medicine, Alpert
Medical School, Brown University. She is also a member of the Digital Health group on LinkedIn.
Medical School, Brown University. She is also a member of the Digital Health group on LinkedIn.
