Projects, designs, and writings on health IT

2014-04-22

How the practice of prepopulating progress notes died

2:51 AM Posted by David Do, MD , No comments

Nostalgia

I spoke to a senior resident who reminded me that overnight interns used to print and populate progress notes for the daytime team before their arrival. I got the sense he was implying "they don't make them [interns] like they used to". Curious about how this practice could have disappeared entirely, I did some investigation. As it turns out, interns used to handwrite vital signs (and their 24-hour ranges) on every single progress note.


Temp: (99.3 - 101.1) HR: 67-82O2: 91-92BP: 90-125/ 50-60RR: 16-20

Even with a computerized EMR, and digitized vital signs, it can be incredibly time consuming to look at graphs for 5 vital signs x 8 patients and translate it to the above format.

How this practice died

Once we pushed the IT department to automatically populate vital signs on the progress notes, we experienced tremendous time-savings. Printing your own progress notes in the morning became trivial, and the practice of pre-populating them became of marginal benefit.

Interns jobs are still very much automatable

Interns, come in earlier than the rest of the medical team to collect data. I estimate 75% of my time is dedicated towards data collection; that is, looking at paper and digital sources of data and scribbling it on the progress note. (When we shift two electronic provider documentation, I will spend my time flipping between screens and using copy-paste.)

Perhaps 10% of my time is dedicated to synthesizing data. What might be causing this sodium value to be so high? How might a high sodium value be causing this patient's confusion? How can I adjust the insulin regimen to keep my patient's glucose better controlled? What should I do with the results of this chest x-ray?

Finally, the last 15% percent of my time will be spent at the bedside, asking a few questions and updating patients about their results.

75% Data collection
10% Data synthesis
15% Patient interaction

Why this matters

Data collection still takes the majority of my time every morning, but luckily, it's the most automatable step. In fact, I think its entirely automatable. IT departments need to start prioritizing workflow and time-saved. It's my hope that through this design blog, we can shift some of that data collection time towards patient interaction.


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