The misunderstood patient: Doctors & their checkboxes

Physicians have become so burdened with the creation of clinical documentation – through a series of screens, clicks, and checkboxes – that they risk compromising the essence of the patient story. But it’s not their fault. What they need is adaptable technology that meets them where they are, on any device, at any time, making it easier for them to focus on the patient.
Physicians need the right technology to be able to tell the full patient story, reflected through clinical documentation in the EMR

The physician’s life has become very complicated with the continuous increased demands being applied to the creation of clinical documentation. This has manifested itself in the electronic medical record (EMR) with more clicks and more demands placed on the physician. When talking to physicians, one of the biggest problems I hear is that when they try to convert what the patient is telling them into a bunch of structured information through clicking and checking boxes, the nuances of what the patient is trying to communicate is basically lost. For example, a 56-year-old woman who runs up the steps and slips on a jelly donut could be easily misdefined as “dizziness causes a fall” in an electronic chart, which means something very different to a physician.

We have uncovered numerous issues by comparing the structured information of apparently similar patients. When reviewing the actual patient story, these same patients look quite different; but when this story is cast into structured information, the patients appear almost identical. Why? The regulatory demands driving more structured input has manifested itself in the technology and produced an unintentional consequence. The entire patient story with all its richness and context is being reduced into a set of variables and attributes in the EMR. With the advent of “open notes” and transparent patient information, this leaves the physician caught between regulatory requirements, click-based technology, and fulfilling the patients’ unique treatment needs.


Document (and really tell) the patient story

As a technologist and a consumer of healthcare, I know we can do better. Technology exists today that allows a physician to tell the patient story with all of its subtleties and uniqueness and also efficiently produces the regulatory required structured information in a completely streamlined manner. Speech is a big part of this because it is the enabler of natural documentation capture. We all experience this every day when we experience the so-called Internet of Things. We are all are talking to everything from our phones to our TVs and cars.

Today physicians can follow their natural thought process, dictating a note into the EMR using cloud-based voice recognition, which is 2-3 times faster than typing. Behind the scenes, clinical language understanding technology can extract structured data, pulling golden nuggets of information (problems, medications, allergies, social habits, etc.) and populating fields in the EMR, thereby making the unstructured narrative actionable and easier to report for Meaningful Use, core measures, quality reporting, and so on. This means the doctor can spend more time in front of the patient, naturally capture their story, and in the end get back to focusing on the patient. This all works with and enhances the EMR experience.


Unchain docs from their desks

If you look back just 5-6 years ago, physicians where welded to Computers on Wheels (COWs) or specially-purposed desktops in specific locations in the hospital; the technology was forcing very limited usage patterns. Since then, literally everything has changed. There are still desktops and COWs but now mobility has taken over; thin clients, every incantation of virtualization you can imagine, browser-based technology, and more – and the physician is welded to nothing. They are completely mobile and they want to maximize technology fully to make it easier to capture documentation wherever they are, on any device, at any time. This is essentially how medicine was practiced before all of this technology anyway. Communicating information about the patient in places outside the EMR, and outside the four walls of hospitals is also becoming more common. Physicians use mobile devices, download apps, share images through the cloud, and post notes to patient portals while texting each other to stay up to date. All of that information is part of the patient’s story and is critical to making clinical documentation and patient care better.

As this happens, and we all start focusing on things other than regulatory requirements, everyone will finally start to shift attention to a user experience that actually really does make a difference to the physician and not just to the government. They will start to make it easier for physicians to use technology, which will reduce the clicks, and eventually physicians will start to get a boost in productivity without the disruption. I think we’re still a few years from the tipping point, but we are moving to that Star Trek scenario where everyone is talking to their devices and their applications are intelligent and connected, and the magic of deriving intent and structure from the spoken word will no longer be so special.


Fewer clicks, more face time, better care

While there may be a generational gap in comfort levels with technology, patients seem to approve of any technology or tool that works best for their physicians. There seems to be no appetite for technology coming between patients and their physicians and this is driving all of us in the right direction. A 2015 patient survey commissioned by Nuance found that patients trust their physicians and defer to their judgment on using technology as long as it enhances instead of detracts from the physician-patient interaction during a visit. I can’t say that point and click has done that, but no one wants to go back to paper.

With the technologies available today and those on the horizon, we can drive major advances in helping to improve the physician experience. But we will need to establish guardrails so people use them properly and preserve the patient story, privacy, and security as part of the patient-healthcare experience.


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Joe Petro

About Joe Petro

Joe Petro is the senior vice president of engineering for the Healthcare division where he leads a large global team on research and development of the entire Nuance Healthcare product portfolio, and collaborates with clients to bring solutions to market. Prior to Nuance, Joe was the senior vice president of product development at Eclipsys Corporation, a major player in the electronic health record (EHR) and clinical provider order entry (CPOE) space. While at Eclipsys, Joe served on the executive staff where he was responsible for the development of more than 30 products from ADT, Departmental, Inpatient, Ancillaries, Patient Financial Management and Outpatient solutions. He earned an M.S. in Mechanical Engineering from Kettering and a B.S. in Mechanical Engineering from University of New Hampshire, graduating both with Summa Cum Laude accolades.