EHR and Health IT Consulting
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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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EHR and Challenges of the Modern Medical Note

EHR and Challenges of the Modern Medical Note | EHR and Health IT Consulting | Scoop.it

There was a time when documentation was an almost inconsequential process. After seeing a patient, the doctor would scratch a note, close the folder, and file it on a shelf until the next visit.

 

Things are different and the medical note has evolved. As it’s evolved, electronic health records (EHR) have brought efficiencies to the medical note while introducing new challenges. And like the cognitive biases that impact patient care, the problems inherent in documentation need attention.

 

Thinking about these challenges becomes important in documenting care and training the next generation of health professionals. Here are a few that I think about

Auto Documentation

One of the powers of the EHR is that it allows users to auto-populate the medical record with chunks of pre-fabricated text known as smart phrases. But these personally created building blocks of the medical note create the potential for one-clip-fits-all documentation. As I’ve said in the past, the smart phrase is not new technology.

 

I work to keep smart phrases out of my history of present illness and impression where individualized narratives show what’s unique about a case. Free text keeps me real.

Replicability

While smart phrases represent the dropping of self-created language, we have the ability to clip and paste information from other parts of the chart. This may include bits and pieces from notes penned by another medical professional.

 

While we all lift bits of language from places like CT and biopsy reports, issues arise when the origination of our language is that of another health professional. Epic now allows visualization of a phrase’s origin when not created by the author.

 

I’m careful about what I copy. I’m twice as careful with what I paste as a representation of my own thinking.

Size and absence of constraint

While smart phrases are limited only by our imagination, a digital note with no constraints predisposes to note bloat, one of the looming threats to modern medicine. Pre-digital notes were constrained by writer’s cramp.

 

I’ve laboured through notes where every single lab drawn on a complicated patient is dumped into the note. Pages and pages of marginally abnormal CBC and metabolic panels create a scenario where it’s difficult, if not impossible, to discern what data is relevant to the decisions made.

 

I try to consider the needs of the end user of the note. Of course, this is challenging when our opinion of what constitutes a ‘good note’ varies from that of the note read.

Ambiguity of purpose

This is the most remarkable phenomenon of the modern medical note. Medical notes have traditionally had pet purposes. Medical students learn early on that ‘the right way to write a note’ varies not only by speciality but by the whim of the individual physician responsible for the note. Physicians with firm views regarding what constitutes the purpose of a note may even morph their perspective depending upon the nature of an individual case.

So if you ask 3 physicians the purpose of a medical note and you’ll get 5 answers ranging from billing and quality documentation to legal coverage and professional communication. Over time the medical note has morphed into all of these things at once.

 

The problem with an ambiguity of purpose is how to manage the expectations of the end user. A physician who feels compelled to paste three months worth of blood results into the data portion of a note will be at odds with someone like myself who believes that a note serves to offer nothing other than concise support for what I’m thinking and planning.

 

As notes become more visible to more folks we can expect ambiguity of purpose to become more pronounced. Digital notes and their capacity for customization amplify this divergence of purpose.

Scaling visibility of the EHR

Once restricted to the shelves of offices in big buildings, medical documentation has traditionally been siloed. This was fine because notes existed for the doctors who occupied those individual offices.  The medical note is now enjoying new freedom in its electronic shape. More notes are more visible to more professionals. This is evident within consolidated health systems where networks of offices connect to big hospitals.

 

Beyond professionals, patients are watching and, in some cases, editing their own notes. OpenNotes is a related program based in Boston’s Beth Israel hospital. Regular patient review and revision represent a revolutionary move in medical documentation.

This scaling visibility of the modern note brings greater scrutiny for what we do or don’t do.

 

This idea of the medical note and its evolution gets little attention yet it represents the core medium of all documentation by medical professionals. It deserves more thorough attention and study.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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Essential Questions for Picking EHR Patient Portal Software 

Essential Questions for Picking EHR Patient Portal Software  | EHR and Health IT Consulting | Scoop.it

It’s time to revisit the much undervalued, if much maligned, patient portal. To date, patient portals remain an underutilized resource. But a convergence of trends may change your thinking about their value — especially when selecting or upgrading EHR software. To help with that process, we offer a 10-point checklist for evaluating a patient portal’s usability and functionality. 

Patient Portals: A Mixed Bag

Most of us have used a patient portal, and the reviews are mixed at best. A product of meaningful use requirements, they were mandated as a way to provide patients with timely access to their healthcare.

At their most basic, they’re used to retrieve lab results, ask a question or update patient profiles and insurance providers. Some allow patients to schedule appointments and pay bills. For providers, they represent an opportunity to increase patient engagement, promote loyalty, manage costs and streamline workflows.

In reality, their potential has yet to be harnessed. Hard to access, patient portals are often badly designed, cumbersome to navigate and limited in utility. It’s sometimes easier for patients to pick up the phone and call their provider than to look up their user name or create a new password. For staff and physicians, they require time and resources that aren’t usually billable.

Emerging Trends Impacting Patient Portal Usage and Importance

So beyond next-stage meaningful use requirements, why should the patient portal receive greater consideration in the EHR selection process?

Value-Based Care

First and foremost, as healthcare moves from fee-for-service to value-based care, providers will have further incentive to improve the patient experience, track compliance and manage costs.

In a medical research paper — Patient portals and health apps: Pitfalls, promises, and what one might learn from the other — issued last year, the authors asserted that “the push for reimbursement that relates to value-based care creates an opportunity to develop high-quality patient portals.”

In addition to improving patient health and facilitating wellness, patient portals have the potential to free up staff time, lower call volume (including call backs and phone tag), increase accuracy, reduce duplication and cut down on time spent on patient records, payments and prescription refills.

Data

The future of health and medicine points to the primacy of data. Patient portals can yield a trove of information not captured in a doctor’s visit or clinical interaction — resulting in better population health management and a better ability to track patient engagement and improve adherence to treatment plans.

Patient as Consumer

Patient portals will grow in popularity as patients evolve into healthcare consumers. Increasingly, they want better, faster access to their health information, and to be involved in the medical decision-making process. Patient portals are a natural extension of the trend to go online to select a provider or research medical conditions and treatments. They’re going to expect a positive user experience, rewarding those who do with their loyalty.

Mobile Apps/mHealth

The growing use of mobile apps, smartphones and wearable devices to monitor and upload information about their health and physical activity facilitates more patient self-management and data exchange with their patient portal.

10 Point EHR Checklist for Evaluating Patient Portal Usability

Given the patient portal’s potential and growing importance, how should you evaluate the best portal for your practice or facility?

As a healthcare provider, you can select a standalone patient portal that oftentimes is hosted by a third-party vendor. This approach can result in compatibility issues with your EHR system, requiring your EHR vendor’s cooperation — often at a price.

Alternatively, you can select a patient portal as part of an EHR bundle of services. The good news is that most EHR systems provide a patient portal component. When evaluating their product, you need to remember that patient portals are not all created equal, and can vary in functionality and usability. As such, you need to take into consideration:

  1. Cost – What is the cost to design and activate the portal? Do they provide training, maintenance, troubleshooting and upgrades?
  2. Customization – Do you have flexibility to customize the interface to take into account your practice, specialty and patient profile?  Is it white-labeled to allow for branding?  Do providers have the ability to make refinements?
  3. Patient Management – Does it provide the ability to refill prescriptions, monitor compliance, track patient progress, schedule/cancel appointments, pay bills, upload documents and download practice forms? If they don’t provide all these services, which ones are most important to you?
  4. Communication – How easy is it for patients to send and receive emails and messages? Can patients upload documents? And does it easily and securely integrate with mobile health apps, in a format that providers can use?
  5. Patient Access – How complicated is it for patients to set up an account?  Is it a multi-step process?  Does it incorporate “responsive design” so that it’s accessible and easily readable on a computer screen, mobile device and a smartphone?  
  6. Usability and Navigation – Is the user experience intuitive, consumer-friendly and easy to navigate? Does the portal present information such as test results in a way that patients can understand and interpret? Can it account for sight-impaired patients and patients who don’t speak English?
  7. Content – Can patients view laboratory results and track immunizations, medications and allergies? Can they access personal health data, notes from physicians and medical histories?  Can they renew medications; update their information (insurance, address changes, etc); view discharge and medication instructions; and access an online healthcare library of educational resources?
  8. Security – Is the site HIPAA-compliant to ensure privacy? How secure is the connection in protecting stored data and guarding against data breaches? Does it meet confidentiality and legal requirements for minors? What is the process for setting and resetting passwords?
  9. Workflow automation – Once patient information has been reviewed and approved, can it be uploaded into your EHR (including care plans, clinical visits, insurance coverage, billing) without additional keying or extra work that can result in errors? Can this process be customized to meet your current and future requirements as procedures and policies change? Can it send alerts?
  10. You: The patient portal is evolving, gaining wider acceptance and growing in importance. Not every EHR can address all of these considerations in a manner that meets your needs. Its components are only part of the equation. The other part is you and your commitment.

For starters, do you have a physician champion or super-user who’ll advocate for your patient portal?  Can you ensure that staff are properly trained, and that it’s maintained and regularly upgraded? Are you willing to commit the resources to ensure it’s routinely monitored and being used properly? Do you have the resources to create awareness and educate patients on how to use and maximize its benefits? And do your internal policies and procedures encourage usage?

Ultimately, you can’t guarantee patient compliance or participation. However, you can select a portal that helps you achieve your business goals and meets your patients’ needs.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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