As I’m wont to do, I was spending some time on the Twitter machine a few weeks ago. Can Twitter be a huge waste of time? Absolutely! Yet, if you follow the right people (and avoid the bots), you can learn a thing or two. One of the magical — and horrible — aspects of the internet is that anyone who has something to say can say it. This allows the world to learn smart things from folks who likely wouldn’t have such a megaphone in real life.
I follow a bunch of physicians (hello, #medTwitter), one of whom is @mcsassymd, an emergency medicine resident. I don’t know anything more about her, but she caused a bit of a stir with the following tweet:
Our Epic changed the alert from "you are entering the record of a deceased patient" to "you are entering the record of [name], who passed away on [date]" and I think it's really really really nice.— Sass, MD (@mcsassymd) August 8, 2020
There were differing opinions about whether or not this change to Epic’s code base was “really really really nice.” Based on the number of likes, I think Dr. Sass is right. Many physicians noted that even though we generally try to be scientific and often must leave emotions at the door to do our job, it can be helpful to humanize the cold tech of the electronic health record (EHR) with little touches here and there.
Is passed away simply a euphemism? Sure, but we should be able to forgive a minor rewording if it helps us remember we’re poking around in the chart of someone’s parent, sibling, child, or friend.
I think these small healthcare information technology changes can have outsized results, both on clinical/operational staff as well as on their patients. The addition of customer relationship management (CRM) software has been a boon to personalizing the experience of interacting with a large hospital or clinic group. Before we had well-developed (and well-implemented) CRM systems, when calling to get help with a bill or appointment question, patients had to give all sorts of information to the representative because the rep didn’t have any context when answering the phone.
With CRM, if an established patient calls, the rep might already know key details such as the patient just received a bill, recently viewed a test result, or called last week about an outstanding issue. By anticipating these needs, the forward-thinking health system shaves a few minutes from a phone call and, more importantly, keeps the patient thinking positively about their hospital or clinic. CRM systems can also give a phone operator or receptionist the ability to remind the patient of deferred preventive health needs like vaccines or screening tests; in other words, a quick question about a bill can be converted into a potentially life-saving encounter.
Sometimes little improvements in tech with big outcomes for users don’t even require your friendly software developer to institute. Consider the APSO note. For decades, physicians have written progress notes following the SOAP paradigm:
- Subjective (how does the patient feel?)
- Objective (vital signs and physical findings)
- Assessment (what does the doctor think is happening?)
- Plan (what’s to be done)
A SOAP note makes complete sense as it follows the typical flow that occurs in an office visit. Yet, it falls down in the EHR for two reasons:
- The most important information (assessment and plan) is at the bottom.
- When scanning through a bunch of notes on the screen, the physician has to click on the note and scroll down to see the good stuff.
Wouldn’t it be great to see the most important part of the note quickly and easily? APSO makes that happen. Put the good stuff in the most obvious place and make it easy to find. A study from the University of Colorado’s Dr. CT Lin showed that 81% of physicians who used APSO notes thought it was easier to find data, and most found it faster as well.
In fact, you can learn more about APSO and other ways to reinvent the physician note at Nordic's upcoming webinar, "E/M Code Changes: What will happen to the physician note?" on Sept. 16, 2020. Register here.
Little changes can have big effects. The wins from making small improvements aren’t always obvious, so you might want to put some time into possible outcomes before dismissing ideas.