The following came in as 'Thoughts from a Surgeon':
I have gone over the Gawande essay, here are my reflections:
1. It's long piece and, like much of his writing, it meanders a bit and doesn't really reach a firm conclusion or suggest solutions, except to say that the adoption of digital health records may have some unanticipated side-effects that we should guard against.
2. The issue of user burnout related to clinical information system use is real and will probably hit clinic-based docs hardest.
3. It amazes me how much documentation I ignore or skip over in an average day. If I can't skip to the important stuff in a clinical information system (CIS) [Connect Care], my work is going to grind to a halt. The "Revenge of the Ancillaries" is a real risk and could lead to a bloated and unusable system.
4. Ensuring a good user/provider experience is the key to success. How will providers use the system efficiently every day?
5. Proving room for innovation and customization inside the system is also going to be essential.
Here is a detailed list of the actual clinical documentation I do in my own practice:
in clinic space
- see patient, scribble illegible note on health organization paper
- occasionally write a prescription on paper pad
in the office after clinic
- dictate my own detailed letter, copy and paste text into my electronic medical record (EMR)
- complete OR booking form, H&P and pre-op orders in CIS, medical office assistant sends to the OR
- check lab results in EMR
- enter billing codes in EMR
day of surgery
- dictate OR note at end of procedure (unless resident does it)
- resident does post-op note and orders, I rarely do this.
on the ward
- I never write in the chart, residents do all of that
- occasional verbal orders
- dictate discharge summaries which make their way to the provincial electronic health record (EHR)
in endoscopy suite
- scribble illegible note on health organization paper
- dictate my own endoscopy note for attachment to the provincial EHR
At home
- I never do any clinical documentation from home, I don't even have EHR or EMR access and I don't want it!
As you can see, I have developed what I think is a highly-efficient system designed to minimize the time I spend on clinical documentation. I bet most of my colleagues do something similar. I'd love to see what our new workflow will be like in the Connect Care CIS...