A new approach to clinical documentation can help.
By Marc Mosier, MD, Chief Medical Officer for Pri-Med / Amazing Charts
FEBRUARY 5, 2016 – The news about misdiagnosis (“Most Americans will get a wrong or late diagnosis at least once in their lives,” Sept. 22) should not have surprised anyone who works in health information technology. For all the potential that technology holds for improving the quality of healthcare, the sheer volume of information and how it is captured and presented often has the opposite effect.
Patient encounters are generally misunderstood by the designers of electronic health record (EHR) systems, whose primary objective is to make practices more “efficient.” Physicians think in problems, but EHR systems organize patient data by source. For example, lab results for a particular patient are commonly presented in a single list, regardless of the problems for which they were ordered. The same source-based organizing principle is used for medications, exam notes, orders, referrals, etc.
A primary care provider seeing a patient with three active problems must mentally juggle an average of twenty individual data points during the visit. If the physician sees 15 patients per day, she is handling more than 300 critically important pieces of information. Miller’s Law famously states that the number of objects an average human can hold in working memory is 7 ± 2, or a maximum of nine.
No wonder physicians often feel as if they are drowning in an ocean of disorganized data when confronted with patients having multiple problems. The capacity to effectively multitask is often stretched beyond its limits, leading to cognitive overload, which impairs the medical decision-making process and can lead to misdiagnosis, medical errors, and other potentially life-threatening mistakes.
Part of the solution to this dilemma is a problem-based approach to organizing information and workflow, whereby notes, medications, labs, orders, referrals, etc. are associated with specific patient problems. The problem list provides a “table of contents” of specific relevant clinical issues that can be viewed longitudinally over time.
This intuitive interface allows the physician and patient to set an agenda for the office visit and then review problems in a way that supports the nonlinear nature of a medical encounter.
Perhaps most importantly, an EHR that uses patient problems as its organizing principle can help reduce cognitive overload in the exam room. Physicians will see patient health information associated with a specific problem(s), easing the number of mental connections required to make a sound medical decision and, by extension, reducing risk of misdiagnosis and error.
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