HIN204 – HEALTH INFORMATICS TECHNOLOGY & CLINICAL PRACTICE

Electronic Clinical Documentation (ECD)

ELECTRONIC CLINICAL
DOCUMENTATION
ELECTRONIC CLINICAL
DOCUMENTATION
Activity
1. Break out into three groups:
▪ Online group
▪ Two in-class groups

2. Identify all components of clinical documentation you can

think of (5 minutes)
3. Share with the class
ELECTRONIC CLINICAL
DOCUMENTATION
The American Health Information Management Association and others
define clinical notes by enumerating a cluster of note types e.g.:
▪ Admission History and Physical Examination Report (H & P)
▪ Progress Notes
▪ Consultation Reports/Notes
▪ Discharge Summary
▪ Operative Reports

They then specify various elements of these notes e.g.:

▪ Chief Complaint
▪ History of Present Illness
▪ Past Medical History, Family History, Social History
▪ Review of Systems, Assessment, Plan
ECD – HISTORICAL CONTEXT
Stand Alone Entries Integrated/Holistic Problem
Lists
▪ In the 1960s – 1980s Lawrence Weed advocated that patient records
needed to be redesigned to function more as longitudinal records of the
patient’s trajectory rather than as isolated stand-alone entries for each
clinical encounter
▪ He advanced the idea of tying notes together via “problem lists” using
SOAP (see next slide)
▪ This was revolutionary and transformative, with most practices and
practitioners adopting this new format to varying degrees
▪ In addition, Weed posited that such records needed to be electronic rather
than on paper, something that only decades later would become a
widespread reality
PROBLEM-ORIENTED MEDICAL
RECORD
▪ Subjective:
▪ Observations that are verbally expressed by the patient, such as information
about symptoms
▪ Considered subjective because there is not a way to measure the information

▪ Objective:
▪ Factors you can measure, see, hear, feel or smell (e.g. vital signs)

▪ Assessment:
▪ The diagnosis or condition the patient has (may be one clear diagnosis, may be
multiple)

▪ Plan:
▪ Refers to how the patient’s problem will be managed/addressed
▪ It may involve ordering additional tests to rule out or confirm a diagnosis
▪ It may also include treatment that is prescribed, such as medication or surgery
SOAP
ECD – HISTORICAL CONTEXT
▪ 1991 – Another landmark event was the Computer Based Patient
Record Report from the Institute of Medicine (IOM; now the National
Academy of Medicine) Committee, which envisioned new ways in which
electronic health records (EHRs) could transform notes and care.
▪ During the ensuing quarter century, a host of “home grown” and
commercial systems implemented various aspects of the HER, inspired
by ideas contained in this report.
▪ Often starting with ancillary areas such as:

▪ Laboratory results storage/lookup

▪ Electronic ordering of tests and medications
The conversion of notes from paper to electronic eventually rose to the
top of the agenda for hospitals and clinics.
ECD – HISTORICAL CONTEXT
▪ However, the road has been a bumpy one, with various hybrid solutions
such as scanning of paper handwritten or dictated notes, and systems that
maintained dual systems of paper records that include hard copies of
electronic notes/reports, as hybrid solutions.
▪ Such notes are not searchable, or even at times (in the case of scanned
handwritten notes) not legible.
▪ As the road to full electronic notes is becoming better paved, new
potholes have arisen and have led to a series of recent thoughtful reports
spotlighting these issues.
ELECTRONIC CLINICAL
DOCUMENTATION
It is well recognized that electronic clinical documentation (ECD) is one of
the key tenets to good clinical care. Specifically, its:
▪ Structure (how it is designed)
▪ Processes (how it is used, during and outside the visit)
▪ Outcomes (the notes produced and the care they drive)

Each of these provide the foundation for high-quality patient care, efficient
and effective care delivery, and clinician and patient satisfaction.
ELECTRONIC CLINICAL
DOCUMENTATION
▪ Good/improved clinical notes are essential for clinicians to be good
diagnosticians
▪ At the simplest level, depending on human memory to recall key details
from the history or physical exam is unreliable
▪ Notes are an essential vehicle for recording thought processes for
ourselves and conveying these with other care team members
▪ Writing notes should not only support diagnostic assessments, but also
ought not distract providers from paying attention to and thinking about
the patient [design for balance]
▪ Better ECD has the potential to improve diagnosis and prevent diagnostic
errors
ELECTRONIC CLINICAL
DOCUMENTATION:
CHALLENGES
ACTIVITY
Activity
1. Break out into three groups:
▪ Online group
▪ Two in-class groups

2. Identify the key concerns with ECD (10 minutes)

3. Share with the class
ELECTRONIC CLINICAL
DOCUMENTATION
Even with these elements of quality, there are a series of concerns with
electronic clinical documentation:
1. Note bloat
2. Usability
3. Time burden
4. Information overload
5. Barriers associated with interoperability & workflows
6. Dehumanizing the clinical encounter
CHIEF COMPLAINTS
▪ Note bloat
▪ Notes have become filled with templated/checkbox items and copy/
pasted information
▪ Often of little relevance to current encounter
▪ Often containing inaccurate/out-of-date information
▪ Also often include duplicate information that is present in other sections

▪ Degraded usability (stemming from the above)

▪ Note readability has been compromised with difficulties in being able to
see key information at a glance
▪ Preventing a succinct meaningful picture of how the patient’s illness is
evolving (key points lost in ‘a sea of words’)
▪ Inability to see the clinician’s thinking and management plans
▪ Poor and non-standardized formatting and design
CHIEF COMPLAINTS
▪ Time burden to write notes
▪ Spending many additional hours completing their notes after clinical sessions
(often at home of after shift ends), with resulting complaints of unsustainable
workloads, burnout, and decreased family time
▪ Excessive additional documentation requirements mandated for risk or quality

▪ Information overload/overlooked
▪ Massive numbers of notes that are impossible for any human to review
▪ Difficult to ensure that important items that need follow-up are tracked
appropriately over time and not overlooked

▪ Interoperability barriers
▪ Still suffer from lack of access to electronic notes residing in other systems
▪ Due to the inability of various systems to communicate with each other
▪ Requiring clinicians to look in different systems – time and quality of care
issues
CHIEF COMPLAINTS
▪ Suboptimal note-writing functionality and integration with workflows
▪ Excessive mouse-clicks/checkboxes, poor screen design, and confusing and
burdensome navigation
▪ Information often has to be entered multiple times

▪ Impaired note reliability & errors

▪ Owing to a number of the above factors, out-of-date and outright erroneous
information is being included in notes
▪ “Normal” checkboxes are checked even for items not asked or examined
▪ When two charts are open simultaneously, information risks being written
or pasted into the wrong patient’s note
▪ Accuracy of note can no longer be assumed and users complain that they
can no longer trust what they read in notes

▪ Dehumanizing the clinical encounter

▪ Clinicians may feel the need to pay more attention to the computer screen
than to the patient
ELECTRONIC CLINICAL
DOCUMENTATION:
KEY GOALS
EIGHT GOALS FOR ECD
1. Accurately Record Key Information From the Encounter
2. Produce Notes Quickly and Efficiently
3. Meaningfully Portray Patient’s Unique Story and Clinician’s Thinking
4. Support Diagnostic Decision Making
5. Help Ensure Problems Do Not Got Lost or Overlooked
6. Succinct, Organized, Usable by Others
7. Tool to Facilitate Coordination Across Visits, Team
8. Ensure That Note Is Error/Defect-Free
ACCURATELY RECORD KEY INFORMATION
FROM THE ENCOUNTER
▪ A few years ago, any discussion of the goals of clinical notes would
start and end here
▪ “Make sure you document” xyz for ensuring a “complete” note, and
document exhaustively to support care or malpractice claim protection
▪ These issues have not gone away and unfortunately still dominate the
thinking of many physicians, administrators, and insurers who are
concerned with note “completeness.”
▪ But our understanding of the details, workflow processes, design, uses
and users of notes is evolving and hopefully maturing
▪ The note should be a tool to help clinicians to provide better care
ACCURATELY RECORD KEY INFORMATION
FROM THE ENCOUNTER
▪ Redesign should be linked to the needs of the note author (clinician)
to provide best possible patient care
▪ Information should be automatically recorded and updated where
possible
▪ Rather than a copy/pasted model, a dynamic link to relevant
electronic data existing outside the note should be used for
▪ Vital signs
▪ Age
▪ And so forth
ACCURATELY RECORD KEY INFORMATION
FROM THE ENCOUNTER
There are conflicting views about what should versus should not be
included in notes:
▪ For example, should the list of patient's medications be included in the
note versus residing solely in the medication ordering section of the EHR?
▪ Certainly, the ability to create a time-stamped snapshot documenting the
exact regimen at that moment (prior to any changes being made at that
visit) could be of value, but this duplicated information can add to note
bloat
▪ Likewise, bringing test results into the note and grappling with abnormal
findings that are then reviewed and discussed with the patient during that
encounter is valuable to document, but risks duplicating information
residing elsewhere.
PRODUCE NOTES QUICKLY AND EFFICIENTLY

▪ An important and legitimate goal of clinicians is to quickly complete

and close their note and move on to the next patient (or note!)
▪ Just-in-time production theory and methods suggest this should ideally
be done in real time or close to real time (occasionally allowing delay
for a pending test result, or for further reflection and research on a
confusing diagnosis)
▪ Large-scale “batching,” in the form of letting scores of unfinished
notes stack up in one’s inbox queue, is suboptimal to finishing the note
while the patient is fresh in mind.
PRODUCE NOTES QUICKLY AND EFFICIENTLY

▪ There are three general formats for entering electronic notes:

▪ Templated notes
▪ Free text notes
▪ Dictated notes

▪ Different specialties and physicians tend to use/favor one over

another. In one study:
▪ Specialists more often used dictation
▪ Primary physicians used template and free text in equal proportions

▪ Increasingly hybrid methods are being used, and scribes and speech
recognition are working their way into the mix
PRODUCE NOTES QUICKLY AND EFFICIENTLY

▪ In general, there is dissatisfaction with:

▪ The time and resulting clinical and economic costs required for note-
writing
▪ Insufficient attention to better designed workflows that optimize efficiency
MEANINGFULLY PORTRAY PATIENT’S UNIQUE
STORY AND CLINICIAN’S THINKING
▪ Notes need to describe and convey in narrative form what is going on with
the patient
▪ Many templated notes give an unrecognizable generic picture of the patient
▪ Their history, the illness time course, response to treatment, and its impact on
their health and quality of life

▪ Clinicians need not write a novel but do need to skillfully and succinctly
craft a narrative that captures the essence of such individualized information
▪ This information ought not to be buried among hundreds of checkbox
defaults/responses
▪ Some have advocated reorganizing notes to place the Assessment first (or
even S-AP-O), but what is needed is more than a simple rearrangement of
the note order
MEANINGFULLY PORTRAY PATIENT’S UNIQUE
STORY AND CLINICIAN’S THINKING
▪ We need new ways of conceptualizing notes and better methods of
recording the evolving narrative
▪ Equally important is the need to capture the clinician’s thinking and
rationale for recommendations made for and with the patient
▪ Assessments in many notes is often just a single word or problem
such as “CHF” (congestive heart failure)
▪ This is hardly adequate to represent a meaningful assessment of the
patient or the problem from that encounter
▪ Just adding the word “stable” after the CHF would convey an infinitely
richer assessment
5D’S
For assessing any major, new, or unstable problem, the “5-D’s” are
helpful for assessment/documentation:

1. Defining the problem(s)

2. Diagnosis
3. Doing
4. Do
5. Don’t Know
5D’S
▪ Defining the problem(s)
▪ Implicit judgments about identifying and defining the patient’s main problem(s)
—so-called problem representation
▪ Describe, justify, group

▪ Diagnosis
▪ Thinking about the causes of these problems, generating differential diagnoses,
and weighing their various likelihoods
▪ Etiology, weighing probabilities, cause of exacerbation

▪ Doing
▪ Looking at the response to treatment and how the patient is doing
▪ How is the patient doing, time course, urgency, response to Rx (treatment),
interpretation of response

▪ Do
▪ What needs to be done, and why

▪ Don’t Know
▪ What are uncertainties, need to follow up
5D’S
▪ It is helpful to document the rationale for next steps, as well as
uncertainties and contingencies
▪ This information is first and foremost for the authoring clinician, a
workspace to work out his/her thoughts, and a way to recall these
assessments the next time the patient is seen as well as share with other
team members involved in the patient’s care
SUPPORT DIAGNOSTIC DECISION-
MAKING
▪ Directly flowing from ECD’s role in supporting and documenting the
assessment is the broader role in serving as a springboard to better
diagnosis
▪ Could better notes and interaction with the computer, for example,
help avoid “premature closure” thereby preventing fixating and
perpetuating a single wrong diagnosis?
▪ Redesigning clinical documentation functionality to better achieve
these “stretch goals”
▪ Many elements are already in place and being used to varying extents
SUPPORT DIAGNOSTIC DECISION-
MAKING
▪ Includes the innovative integration of diagnosis decision support into
electronic notes
▪ Disease-specific history taking checklists
▪ Electronic referrals that can be linked to note documentation
▪ Info buttons that can access online resources such as textbooks and
references in real time while the note is open with the patient
 SUPPORT DIAGNOSTIC DECISION-
MAKING
Role for Electronic Documentation
Providing access to information
Recording and sharing assessments
Maintaining dynamic patient history
Maintaining problem lists
Tracking medications
Tracking tests
Ensuring coordination and continuity
Enabling follow-up
Goals and Features of Redesigned Systems
Ensure ease, speed, and selectivity of information searches; aid cognition through visual
display featuring aggregation, trending, contextual relevance, and minimizing of
superfluous data.
Provide space for recording thoughtful, succinct assessments, differential diagnoses,
contingencies, uncertainties, and unanswered questions; facilitate sharing and critical
review of assessments by other clinicians as well as patients.
Carry forward information for recall, avoiding repetitive patient querying and recording
of unchanged information while highlighting new information and minimizing erroneous
copying and pasting.
Ensure that problem lists are better organized and integrated into workflow to allow for
continuous updating and incorporation into notes.
Record of medications patient is actually taking, patient responses to medications, and
adverse effects to ensure timely recognition of medication problems and avoid drug
reactions being misdiagnosed.
Integrate management of diagnostic test results into note workflow to facilitate and
ensure reliable review, acknowledgment, assessment, and action in response, as well as
documentation of these steps and rationale.
Aid in aggregating, integrating, summarizing, data from all care episodes and fragmented
encounters (especially “interval history”) to permit thoughtful synthesis, ideally crafting
of wiki-like summary.
Facilitate patient education about plan, potential red-flag symptoms to watch for; help
ensure and track any needed follow-up.
 SUPPORT DIAGNOSTIC DECISION-
MAKING
Role for Electronic Documentation Goals and Features of Redesigned Systems
Providing feedback Automate feedback to upstream/prior clinicians, facilitating their learning from
subsequent diagnosis-related outcomes and misdiagnoses.

Providing prompts Provide checklists to minimize reliance on memory (e.g., for ensuring key history
items or differential diagnosis considerations) to direct questioning and support
diagnostic thoroughness and problem solving.

Providing placeholder for resumption of work Delineate where in diagnostic process clinician was and should resume after being
interrupted to prevent lapses in data collection and diagnostic thinking.

Calculating Bayesian probabilities Embed calculator into notes workflow to reduce weighting errors and minimize
known biases in subjective estimation of diagnostic probabilities.

Providing access to information sources Provide instant access to knowledge resources through context-specific
“infobuttons” triggered by key or highlighted words in notes that link user to
textbooks and relevant guidelines.

Offering second opinion or consultation Integrate real-time online/telemedicine access to consultants to provide just-in-
time answers to questions related to referral triage, testing strategies, or expert
diagnostic assessments.

Increasing efficiency Penultimate aim that more thoughtful design, workflow integration, easing, and
distribution of documentation burden would speed up charting, to free up time
for enhancing communication (with patient/others) and diagnostic thinking,
reflection, reading.
SUPPORT DIAGNOSTIC DECISION-
MAKING
ENSURE PROBLEMS DO NOT GET LOST OR
OVERLOOKED

▪ In theory, the Problem List should be the essential vehicle for

ensuring that patients’ medical problems and abnormal findings do
not get lost
▪ In reality, electronic problem lists are problematic, plagued by
multiple issues:

▪ Keeping problem lists updated

▪ Lack of clarity/agreement about what belongs on the problem list
▪ Whose responsibility it is to maintain it
▪ Confusion between simple diagnosis (diabetes) and more complex billing
codes (ICD-10 coding for diabetes and presence/absence of various
complications)
▪ Difficulty organizing problems
▪ Duplicate problems
ENSURE PROBLEMS DO NOT GET LOST OR
OVERLOOKED

▪ Lost in this shuffle is the potential for action-requiring problems to be

overlooked:
▪ Patients having a history of splenectomy (hence need for pneumococcal
vaccination)
▪ Pulmonary nodule (that requires reimaging in 1 year)

▪ What a clinical note linked to the problem list can and should do well
is:
▪ Provide highly visible and reliable closed-loop tracking abilities to ensure
the clinician is reminded of key problems each visit
▪ Opportunity to review outstanding clinical issues
SUCCINCT, ORGANIZED, USABLE BY
OTHERS
▪ How are we going to make notes more succinct, and easier to read
and use?
▪ Multiple strategies will likely have to be pursued to achieve this aim
▪ A starting point would be better consensus around standardized
organization and redesigned display of information
▪ Notes should take advantage of the capability of electronic data to be
entered one way but be displayed in another way
▪ Key nuggets (usually free text narratives) from patient history and
clinician assessment should be easily findable and formatted in a
standardized way
SUCCINCT, ORGANIZED, USABLE BY
OTHERS
▪ Filters should further enable specialized looks at different slices of the
note and allow tracking of temporal relationships
▪ Clinicians’ skill at crafting good notes should not be taken for granted,
but instead warrants inclusion of:

▪ Teaching note-writing skills in clinical curriculum

▪ Continuous feedback
▪ Tips for improvement
TOOL TO FACILITATE COORDINATION ACROSS
VISITS, TEAM

▪ Patient care is no longer a solo activity

▪ Combined with the longitudinal nature of caring for patients with
chronic illness, notes must weave together visits over time and across
space (different providers, transitions of care)
▪ More than just “cc-ing” relevant team members or making notes
widely accessible, serious attention needs to be directed at how notes
might better coordinate care and overcome current fragmentation
▪ Another concept needs to be much better developed— the “Interval
History”— a way to synthesize events and notes since the patient’s
last visit
TOOL TO FACILITATE COORDINATION ACROSS
VISITS, TEAM

▪ Some clinicians manually look up and paste key parts of specialist

visits or discharge summaries (marking this content as copied from
others’ note) for the intervening time since last seen in primary care
and then underlines key text
▪ This primitive and labor-intensive approach needs to be supplanted by
functionality whereby the EHR can help automate such summarization
(i.e. AI natural language processing)
▪ There is growing interest in “Shared Care Plans” as key clinical
document that bridges the multidisciplinary care team with the
patient’s goals for their health and care
▪ The elements of such notes and how to ensure they have a genuinely
beneficial impact on patients’ care (rather than being a nice
looking/sounding piece of additional information that just adds to the
documentation burden of the staff) remain to be worked out
ENSURE THAT NOTE IS ERROR/DEFECT-FREE

▪ Unintended negative consequences are the rule with any technology

▪ ECD has led to the proliferation of inaccurate or out-of-date information
that can in turn cause harm
▪ Fortunately, these are rare events, but the potential for undermining
the trustworthiness and confidence is a more serious and widespread
problem
▪ Six sigma (3.4 defects per 1 million parts) levels of quality is the
standard in many industries
▪ Yet, for example, wrong patient errors (ordering or documenting on the
wrong patient) currently occur in roughly 5 in 10,000 patient orders:
▪ A rate one hundred times greater than this standard from other industries

▪ Patient safety culture whereby clinicians become tolerant and cynical

about untruthful or inaccurate information in their notes can occur
ENSURE THAT NOTE IS ERROR/DEFECT-FREE

▪ While there are promising approaches to error reduction (e.g., for

preventing wrong-patient errors by including the patient’s picture on
screen; manual verification steps or error checking decision support),
these errors are likely to worsen before they get better unless more
attention is paid to the frequency, causes, workflow, and workaround
issues related to error
▪ Thus, we can see the intimate connections between the chief
complaints and these potentials for errors
KEY EMERGING ISSUES IN ECD
▪ Copy/Paste
▪ Easing Entry: Scribes (Team Documentation) and Speech Recognition
▪ Problem-Based Charting
▪ Open Notes
COPY/PASTE
▪ Used to speed up note-writing
▪ Positive benefits include:
▪ The ability to efficiently carry forward unchanged information
▪ Avoid errors in transcribing key information
▪ Efficiently create the structure and populate content for new notes

▪ Copy/Paste is usually used as a workaround for the limitations of data

entry
▪ Focus on improving EHR note production
EASING ENTRY: SCRIBES (TEAM
DOCUMENTATION) AND SPEECH
RECOGNITION
▪ A growing number of practices using an EHR now use medical scribes
▪ Medical scribes involve a clinician dictating into a device that records
and then someone else listens and types the note into the EHR
▪ The time burden for clinicians to write notes drives the prospect of
having someone support charting
▪ While hiring additional personnel to support this function can add
cost, it has been shown to pay for itself in the form of:

▪ An increase in the volume (perhaps one to two additional patients/

session)
▪ Enhanced documentation for capturing billing revenue
EASING ENTRY: SCRIBES (TEAM
DOCUMENTATION) AND SPEECH
RECOGNITION
▪ More fundamental questions about scribes’ role, training, effects on
interactions with patients in the exam room, and qualitative aspects
of note content and production that are important to consider and
remain largely unexplored
▪ How exactly will the clinician who is no longer at the computer
interact with decision support messages or navigate to critical test or
past notes if a non-clinically trained scribe serves as a “middle-man”
▪ Speech recognition represents another transformative tool for
entering information into the clinical note, allowing real-time entry of
text and can even use “commands” to navigate or create structured
entries
PROBLEM-BASED CHARTING
▪ Organizing notes using a dynamically updated Problem List is integral
to good quality clinical documentation and vital to the care of the
patient
▪ These are records that “guide and teach”
▪ A well-curated Problem List provides a “medical portrait” of the
patient and is refreshed/repainted as the patient’s clinical picture
evolves
▪ It has the flexibility to highlight (or put on the back burner):

▪ Critical past diagnoses

▪ Enumerate current acute and chronic problems
▪ Remind the clinician about items (e.g., pulmonary nodule) that need
periodic follow-up
PROBLEM-BASED CHARTING
▪ At a minimum, Problem-Based Charting involves annotation of each
problem on the Problem List
▪ For instance, for a patient with hypertension, the clinician might
document:

▪ The date of onset

▪ Medications tried (and failed)
▪ Relevant family history
▪ Current medication regimen and efficacy
▪ Recent cardiac testing
▪ Whether a specialist is involved

▪ Done once and well, this overview serves as a quick reminder to the
primary clinician, as well as cross-covering providers and specialists,
of the key information relevant to that problem
PROBLEM-BASED CHARTING
▪ A key leap would be to have these problems dynamically updated
each visit as part of charting for that encounter
▪ For instance, in the patient with hypertension, the clinician might
document:

▪ That the patient is adherent with his/her medication regimen (or not)
▪ Any side effects from medication
▪ Whether the patient is following a low salt diet, exercising, and
maintaining his/her weight
▪ Whether they have developed any new or worrisome cardiac symptoms
PROBLEM-BASED CHARTING
▪ While this information has typically resided in the Subjective section
of traditional SOAP notes, the benefit of integrating it with the
Problem List is that:

▪ It becomes visually and cognitively linked with the history and overview of
that particular problem
▪ Enhancing the narrative value of the note
▪ Creating continuity across notes
▪ Creating substantial documentation efficiencies in time and duplicative
effort

▪ In the current iterations of EHRs, we have a glimpse of ways to add an

assessment and plan directly linked to that particular problem
▪ Some clinicians have adopted this functionality to create their own
workflows and variants of problem-based charting
OPEN NOTES
▪ Clinical notes need to be reconceptualized and used as much more
than a paper chart repository documenting isolated clinical
encounters
▪ Instead, notes are dynamic living documents that serve to coordinate
the efforts of a larger team involved in the patient’s care
▪ The care team includes the patient him/herself, who plays a central
role in multiple aspects of their own care
▪ Thus, it is only logical to permit patients to access their notes
▪ Until recently this idea seemed impossibly scary and fraught with
insurmountable concerns
OPEN NOTES
▪ Pioneering “Open Notes” efforts have shown that letting patients
review their own notes has not led to serious feared problems and
has also resulted in multiple positive benefits including:

▪ Giving patients the ability to correct errors they may detect

▪ Helping build understanding and relationships

▪ More than 10 million US patients now have access to their “Open

Notes” and even psychiatry notes have now been opened to patients
at selected institutions
▪ Let’s envision a time when patients will interactively “assess” clinician
assessments giving two-way feedback!
VISION FOR THE FUTURE
▪ ECD will move beyond simply a computerized version of the paper
note
▪ Organizations will leverage the advanced capabilities that
transformative electronic technology offers
▪ At the same time, producing notes will cease to be an extra time-
consuming chore and instead become an efficient, interactive process
▪ Will produce much added value while taking less of the clinician’s
time while more productively engaging the entire health care team
VISION FOR THE FUTURE
▪ Such notes will not only be searchable, but lend themselves to
radically be reorganized, displayed, and aggregated across encounters
and across patients for:

▪ Better care
▪ Research
▪ Learning
▪ Improvement
QUESTIONS?
CLASS PROGRESS