By HANS DUVEFELT
The chronology of a patient’s symptoms is often crucial in making a correct diagnosis. Likewise, the timing of our own clinical decisions is necessary to document and review when monitoring a patient throughout their treatment.
In older paper charts, especially when handwritten, office notes, phone calls, refills, and more were displayed in the order they occurred (usually in reverse chronological order). ). This made it possible to follow the treatment of a case effortlessly, for example:
3/1 OFFICE VISIT 😕 UTI (where ciprofloxacin was prescribed and culture sent)
3/3 Clinical note that culture returned resistant to bacteria and treatment changed to sulfonamide.
3/5 Phone call: the patient developed a rash, a quick handwritten addition to the left side of the file folder, allergy to sulfonamides. New prescription for nitrofurantoin.
3/8 Phone call: now has a yeast infection, has been prescribed fluconazole.
Each of these notes took virtually no time to create and you could see them all at a glance.
In one of the EMRs I work with (hi, Greenway, it’s me again), when the culture returns and I need to change the antibiotic, I open the patient’s file, go to the medication section and press the + sign. The system then asks me which existing “encounter” I want to use for my new prescription. Excuse me, I’m sending a new prescription right now, doesn’t the system know what day it is? How can I send a new prescription dated yesterday today ?? So I have to create a new encounter, choosing “drug encounter” as the type, and then I’m good to go. Kind of. This type of meeting doesn’t show up when I later look at my office notes because they are not categorized as an office note.
When the patient later calls to report the rash, that phone call comes to me as a “task” (oh, how much I despise that humiliating word…), which also won’t fit in the office notes timeline. I can create a drug encounter when I change antibiotics again, just like with the first drug change. I can then use the same encounter to document the allergy. But if I want my actions to show in any type of timeline, I have to use the ‘update chart’ encounter type, which will go into the dating list.
This is all very difficult, and frankly it reminds me of working with early versions of DOS, which many of my readers are too young to even have met.
The time taken to document the simple clinical scenario I described above in my current EMR – and review it the next time I see my patient – compared to when we did it on paper is 5 to 10 times longer.
Some progress, eh.
I wish the EMR had known that when I add a drug, I am doing it today and not yesterday.
I want him to know that this is a drug encounter when I add a drug.
I would like the DME to display the story as simply as the old paper map. I am sure it is possible. Computers can do amazing things. But of course, it’s a question of who the Holy Grail actually serves.
Hans Duvefelt is a rural family physician born in Sweden in Maine. This article originally appeared on his blog, A Country Doctor Writes, here.