Wednesday, February 13, 2013

"Social Documentation" for Healthcare

Every day CIOs are inundated with buzzword-compliant products - BYOD, Cloud, Instant Messaging,  Software as a Service, and Social Networking.

In yesterday's blog post, I suggested that we are about to enter the "post EHR" era in which the management of data gathered via EHRs will become more important than the clinical-facing functions within EHRs.

Today, I'll add that we do need to a better job gathering data inside EHRs while at the same time reducing the burden on individual clinicians.

I suggest that BYOD, Cloud, Instant Messaging, Software as a Service and Social Networking can be combined to create "Social Documentation" for Healthcare.

In previous blogs, I've developed the core concepts of improving the structured and unstructured documentation we create in ambulatory and inpatient environments

I define "social documentation" as team authored care plans, annotated event descriptions (ranging from acknowledging a test result to writing about the patient's treatment progress), and process documentation (orders, alerts/reminders) sufficient to support care coordination, compliance/regulatory requirements, and billing.

Here are a few core principles I'd like to see as the foundation of "social documentation" products:

*Incorporates data input from multiple team members, reducing the documentation burden for each participant
*Eliminates redundant entry of the same information by different caregivers (nurse, pcp, specialist, resident, social worker)
*Supports Wikipedia like summaries (jointly authored statement of history, plans, and decision making)
*Supports Facebook/Twitter like updates i.e. "Patient developed a fever, ordered workup, will start antibiotics"
*Incorporates data already present in the EHR such as orders and results without having to re-describe them in narrative form

Accomplishing this is likely to require a modular architecture with some services offered in the cloud, some on mobile devices, and some via new enterprise software that improves upon insecure consumer offerings (such as institution hosted HIPAA-compliant instant messaging).

I recognize that implementing "social documentation" at a time when we're implementing ICD-10, Meaningful Use Stage 2, new security imperatives, accountable care organization tools to support care management, and healthcare information exchange may seem overly burdensome.

However, Yogi Berra said "If you don't know where you are going, you might wind up someplace else."

I believe that our strategy for ICD-10, Meaningful Use Stage 2, new security imperatives,  ACOs, and HIEs can incorporate the modules that will be foundational for "social documentation" in healthcare.

If 5 years from now, Beth Israel Deaconess is known as the birthplace for the "post EHR" care management medical record and "social documentation", I'll have stories to tell my grandchildren about.


mark said...

John, what do you mean by new security imperatives?

Dr_SteveA said...

I think that makes so much sense. Everyone brings value to the HPI (History of present Illness) and other components of the chart - MD, Pharmacist, Consultants, Social Work, Physical/Occupational Therapy) and it would be nice to have one document with tags for different authors/types of information. It takes a team to properly take care of a patient and the more our documentation can reflect the collaboration efficiently, I think we'll be better off.

Scott Guelich said...

Great post, and this is something we have spent a lot of time thinking about over the past year. It seems that the primary two functions of EHRs are documentation and communication. They do a passable job at the former, but a very poor job at the latter. I believe there was a study done at your institution ten years after EHR adoption, which showed that 50% of clinical communication still occurred face-to-face and only 10% through the medical record. [source]

We could add even more features to EHRs, or we could let them focus on documentation, while building better tools for communication. We have taken the latter approach by building a messaging platform that adds the ability to associate care teams with patients, share task lists, support team-wide discussions about patients, etc. Soon we will also support the Facebook/Twitter feed that you describe.

What are your thoughts on where our communication solutions are headed? Do you them merging with EHRs, or simply becoming more functional while staying independent?

Jay said...

I'm all for finding a way to decrease the bloat, inaccuracy and repetition in the current EHR. Unfortunately the idea of a continually undated "living" Wiki for documentation is DOA if it is not compliant with our Byzantine E&M billing requirements. We doctors would love to write concise notes that actually serve the purpose of delivering healthcare. Unfortunately our overlords seem to see things differently by adding more regulatory documentation requirements, rather than tightening up the already bloated system.

Do you have a plan that will get your idea past the army of coding specialists and RAC auditors? If so, consider me interested.

Edward J Schloss MD
Cincinnati, OH

BTW: If you're ready to move on past the process of developing clinician facing EHR functions, you should probably spend more time in the clinic. Honestly, it feels like we're running DOS 5.0 down here. Recall, it took almost 30 years of development before Steve Jobs could declare the "post PC era" with a straight face.

Dr_SteveA said...

Is there a way to get the RAC/coders back to the goal of timely appropriate documentation? It's just discouraging having an authority over us that shows so little understanding of what good clinical documentation looks like.

medicine for real said...

John - I work for your hospital and the system drives me crazy. I love your ideas about social documentation. I recently talked to someone in IT who asserts that EHR systems sold by companies don't use cloud computing because of security concerns. Also your suggestions still don't make it possible for different hospital systems to communicate with each other. I've been told this is also due to security concerns.