Monday, January 10, 2011

Squeezing Your Medical History Into 7 Tweets?

Can your doctor fit your medical history into 7 "Tweets" (1000 characters)?

As more physicians start adopting government-mandated Electronic Medical Records (EMR), they will be faced with such challenges. Dr. Danielle Ofri reported her frustrations with her EMR system in her 12/30/2010 New York Times piece, "The Doctor Vs. The Computer".

Here's an excerpt:
Estimating my patient's surgical risk and planning for his operative care is not a straightforward process. After our physical exam, I sit down to write a detailed evaluation, because I want the surgeons and anesthesiologists to fully understand the complexity of his situation.

As I type away, I feel like I'm doing the right thing, explicating my clinical reasoning rather than just plugging numbers into a formula. I'm midway into a sentence about kidney function when the computer abruptly halts.

I panic for a moment, fearful that the computer has frozen and that I've lost all my work -- something that happens all too frequently. But I soon realize that this is not the case. Instead, I've come up against a word limit.

It turns out that in our electronic medical record system there is a 1,000-character maximum in the "assessment" field. While I've been typing, the character number has been counting backward from 1,000, and now I've hit zero. The computer will not permit me to say anything more about my patient.

I go back and remove excess articles: the, a, an. Then I try to gain a few characters by using abbreviations: DM for diabetes mellitus, CRF for chronic renal failure. Still, I am over the limit.

A new trick dawns on me. Maybe if I cut back on my descriptions of the clinical problems I’ve already assessed, then I can gain enough characters for his cardiac status and operative assessment.

I nip and tuck my descriptions of his diabetes, his hypertension, his aortic valve stenosis, trying to placate the demands of our nit-picky computer system. Nevertheless, I am still unable to fit a complete assessment into the box.

In desperation, I call the help desk and voice my concerns. "Well, we can't have the doctors rambling on forever," the tech replies.

I want to retort with something snarky, like I hope that his next critical illness clocks in at less than 1,000 characters, but I hold my tongue. Instead I focus on eliminating verbs and prepositions, wondering just how skeletal my text can become...
(Read the full text of "The Doctor Vs. The Computer".)

Dr. Ofri did finally manage to squeeze her patient's medical assessment into the 1000-character limit -- roughly 7 Tweets (Twitter posts). And she did so without compromising patient care, although it took a great deal of work on her part.

Her specific 1000-character limit was undoubtedly set by her particular EMR vendor (as opposed to the federal government). But the fact that hospitals and medical offices will be de facto required to purchase some government-approved EMR system under ObamaCare rules is unlikely to make vendors more responsive to customer preferences. After all, how good will customer service be in an industry when you have to buy one their products?

Welcome to ObamaCare...