With the growing adoption of EHRs, EMRs, data repositories, and cloud-based computing, as well as a wide range of related technologies, clinical IT systems produce vast amounts of data. Understanding this information is crucial to the care delivery process. Medicine has transitioned from a cottage industry of small clinical practices with varying treatment methodologies to one that is based upon data. However, providing high quality care is more than just increasing information volume — no technology system will ever be 100% dependable and should never take the place of clinical diligence and good medical practice.
Care complexity is increased as a result of teams of individuals (clinical and non-clinical) who need to share information on jointly managed patients in real time. Data volume has become a barrier to quality of care due to the large amount of analysis that is necessary to make the data usable. What this has resulted in are “islands of excellent care in an ocean of mediocrity.” This raises a lot more questions that need to be answered. How does one develop practical and usable sets of data for clinical purposes? Which are the important ingredients?
Consider the days before EHRs and other clinical IT systems: not the limitations of paper, but rather the diligence that was required to conduct clinical assessments and manage patients. Without computers, smartphones, and tablets, doctors needed to take detailed histories, conduct clinical examinations, and — in large part — commit the information to memory. This was particularly true in training programs where interns and residents were required to study the patient chart and be able to provide a detailed summary of the patient’s clinical condition and investigations without referring to the record. I am not suggesting that we go back to the days of pen and paper, but there was a certain utility and accuracy that was required when using paper charts that no longer exists with the high reliance on structured data, templates, and reams of information that are generated by machines.
A good narrative and clinical summary has a certain elegance to it that engenders pride. The ability to document a clear history, an objective set of findings, and a plan of management, using the fewest number of words, is somewhat of an art form. Read an earlier blog article: Are You Proud of Your Documentation Using an EHR? A complaint that we hear regularly from users of EHRs is that they have lost the ability to easily produce high-quality narrative notes from the structured data. All of the information is available in the record; it is just more difficult to produce a good narrative in comparison to the old paper chart. More is not necessarily better.
Measurement, analysis, and research are the lifeblood of evidence-based care delivery, necessitating the need to build capability for analytics-driven systems. However with all of the reliance on data, have we lost something important in the process? The ability to generate a good narrative note that tells the story of the patient?
Perhaps this is no longer important. Share your thoughts below.