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The Checkbox is NOT the Patient

The Checkbox is NOT the Patient. Jonathan A. Handler, MD, FACEP EHR Intelligence Newsletter, 30 April, 2013. 15 May 2013. The Premise. The primary purpose of the EMR is to record the patient encounter so that others can read it later – reporting and decision support are only secondary

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The Checkbox is NOT the Patient

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  1. The Checkbox is NOT the Patient Jonathan A. Handler,MD, FACEP EHR Intelligence Newsletter, 30 April, 2013 15 May 2013

  2. The Premise • The primary purpose of the EMR is to record the patient encounter so that others can read it later – reporting and decision support are only secondary • Burdening the care giver leads to reduced care, the EMR should not be part of the problem

  3. Confusing an EMR with “the truth” can create serious problems, including badpatient outcomes

  4. The Checkbox is not the Patient • What happens when there isn’t a checkbox that EXACTLY matches the patient symptom – add more checkboxes? • This leads to the massive proliferation of checkboxes, but no more clarity • Proper diagnosis and care requires that the details of symptomology are capturedin natural language.

  5. “Everything simple is false. Everything which is complex is unusable.” Paul Valery, 1937

  6. Lost in Translation • Standard inputs, whether diagnosis codes or checkboxes, do not contain the full richness of the observation and conversation • If it isn’t captured, it is permanently lost in the record

  7. Do What Comes Naturally • Proper use of natural language speeds up documentation, which improves patient access to care. • Data that naturally lives as free text should be captured, stored, and made available as free text • EMRs should use natural language in preference to structured data

  8. We have overestimated the value and underestimated the costs of structured data, while simultaneously underestimating thevalue and over-estimating the costsof natural language.

  9. It’s About the Outcomes • While clinical decision support systems (CDSS) can create small-to-moderate improvements in adherence to guidelines, most studies show zero-to small impact on actual patient outcomes • Every wasted second of doctor time harms patients by reducing access to care for those waiting to be seen

  10. A Prescription for HIT • Enable clinicians to input data faster and with higher quality by supplementing the EMR’s “point-and-click” with natural language • Reduce clinician effort and errors through greater use of computerized automation • Improve clinician speed and performance through better processes and user interfaces (UIs). In a well-intentioned effort to do the right thing, we are forcing vendors to build terrible UIs. We can start to do better with these two suggestions: • Improve our approach to alerts • Improve our approach to time savers

  11. At the end of the day, it’s not about technologies, data formats, paradigms, or philosophies.It’s about doingwhatever it takes to achieve the mosthealth from everysecond of care.

  12. Discussion

  13. Handler, J.A. The Checkbox Is Not the Patient. EHR Intelligence. April 30, 2013. http://ehrintelligence.com/2013/04/16/white-paper-the-checkbox-is-not-the-patient/ • Martini, K. EHR dissatisfaction: A tech or people problem? Government Health IT. May 06, 2013. http://www.govhealthit.com/news/ehr-dissatisfaction-hit-or-human-problem?topic=08,12,,29,24

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