In the future, instead of piling up auto-generated text blocks, notes could generate graphs that track, for instance, a patient’s blood pressure or kidney function over time, creating a visual aid that both patients and doctors could quickly grasp. “I think that there's a lot of opportunity for these kinds of new writing tools to get more interactive, and to let physicians do more to manipulate and analyze data directly within the note writing interface,” says Rule.
#Duly noted code#
As data analysts develop tools that allow them to pair text blocks with code that can analyze data and generate graphs, the potential exists to make note templates even more powerful-and useful.
To Rule, the real power of the doctor’s note is its ability to tell stories with data, to combine the patient narrative with data-driven decision-making tools. “Things like notes can easily get very long, so it's hard for someone to read afterwards because you can quickly generate a document that has a lot of text.”
“So many clinicians have had this feeling that notes just seem to keep getting longer,” says Rule. More than 50% of the note text was contributed by templates that pulled in boilerplate language and lab values, whereas less than a quarter came from a physician or other member of the care team dictating or typing it in. Moving to some of these documentation aids, there was a concern: Will you lose some of that narrative? Will it get buried underneath a bunch of stuff that's just automatically imported?”īefore coming to UW-Madison, Rule worked at Oregon Health and Science University, where he researched a decade’s worth of medical notes, encountering a phenomenon that’s come to be known as “note bloat.” Rule’s research team found that doctor’s notes got 60% longer over the decade, and they also became increasingly redundant through constant cut-and-pasting. “It's documenting what the physician observed-how they're thinking about your case, the kind of uncertainty in the diagnosis and what they're wanting to do next. “At the beginning, the doctor’s note is a very human document,” says Rule. Given those multiple uses, it is important to understand how notes are created and used. It's shared with other providers and used for administrative tasks like regulation and billing. The doctor’s note is used for a long list of things: It’s a memory aid for future patient visits. “Being able to synthesize that information becomes a challenge due to that structuring.” “Things that might have been written in a narrative form in a note now get scattered a little bit across forms with separate areas for medications and labs,” explains Rule. One focus is on how moving notes to an electronic format has created a bias towards what is known as “structured data”-the segmenting of information into a specific format, rather than a cohesive narrative.
While electronic medical records clearly have a long list of benefits-they’re legible, portable, shareable and can contain real-time alerts for physicians-the field is still growing and evolving, and some challenges have emerged along the way.Īdam Rule, a new assistant professor in the Information School, studies the ways medical and clinical staff use electronic records to document patient care.