If you had an opportunity to watch a practitioner during a clinical shift or day at the office, you would find her pulling a clinical reference out of her white coat pocket, or walking out of the exam room and into an office to open a textbook, or pulling a cellphone out of a pocket, entering the passcode, and clicking on an icon in a program to access some information. Or the practitioner would minimize the EMR and click on a URL to enter an online program, enter a search term, pick from a list, and then scroll to the required information.
The fact is that in the hectic pace of today’s healthcare, these moments are precious; and with the additional time required for the snail’s-pace documentation in the commonly used EHRs, practitioners simply do not acquire the required decision support often enough. If you have to walk down a hallway, put a passcode into a cellphone or leave the EHR user interface, the hurdle to attain support is too high.
In today’s world of information technology, why would the practitioner need to do anything but click or touch one button and have all the necessary decision support immediately visible without ever leaving the user interface? The EMR should be SMART enough to know where the practitioner is and what is needed most of the time. The list should not be encyclopedic, but it should follow the 80:20 rule. In most cases, when treating a laceration of the hand, what information is typically necessary? Make those elements immediately available. In a single click, review the relevant anatomy, close it, and continue managing the patient. In the example below, the Resources for hand injuries are immediately available without ever leaving the EMR environment (Upper Extremity Injury template from Picis ED PulseCheck® in background).
From the chief complaint-specific template, a physician can immediately access the key information they might need to appropriately document “tendon function normal.” In this particular case, we often find that practitioners do not remember all of the tendons on the back of the hand or how to examine them. This is critical information required in managing a laceration in this area and for avoiding a partial or complete tendon laceration. Not surprising, one of the top malpractice lawsuits for extremity laceration claims happens to be failure to diagnose a tendon injury.
The bottom line is that decision support is required to provide the highest quality care possible. It should be built into the workflow, it should be immediately available, and the program should be SMART enough to modify available resources based upon user input. Once again, this speaks to the availability of complaint-specific content, or the program can’t know which decision support would be relevant.
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