Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Brevity is the soul of a good EMR note

Scott Moore, MD
Tech
April 30, 2014
Share
Tweet
Share

Shakespeare said that brevity is the soul of wit. I say brevity is the soul of a good note.

As a resident back in the early 90s I would look at office notes written by older, near-retiring physicians. I’d read these one or two lines written on 3 1/2-inch note cards, turn to my fellow residents and ask, “How can someone possibly document this way?” Years later, I realize the genius, beauty and efficiency of this type of record, and it seems I’m not the only one. There is a crisis in medicine and, in many cases, the introduction of electronic health records (EHRs) has made it worse. Providers have too much to read at the end of the day, much of it adding little value to the care of our patients.

My health records from my own pediatrician, Dr. Patrick Brucoli (who continues to be an inspiration), span nine years and about ten visits, with a total page count of less than two. Granted, I was a relatively healthy kid … but recording ten visits in just 1 3/4 pages? That’s unheard of today. When I have a new patient that has transferred from elsewhere — and in particular, when an EHR is involved, I groan. The amount of time and concentration it takes to get through that chart, and its pages and pages of verbal diarrhea is daunting. The endless nonrelevant review of symptoms (ROS), family, social, enviromental, extensively documented physical, etc. disguises the essential information that is buried within. It is amazing how much of today’s documentation is clearly just automated jibber-jabber.

I compare this to my childhood chart from the 1970s, Dr. Brucoli taking notes in which every word matters. I can truly review the pertinent aspects of the chart in just a fraction of the time that it takes to understand the record from one of my own incoming patients. The beauty is in the brevity, in how clearly those shorter notes communicate what a visit was about. There is much less chance that something will get lost in the weeds of minutia.

Today, in any correspondence I receive from a physician, I trust that he or she has done a comprehensive history and ROS, has asked about smokers in the house and did the appropriate anticipatory guidance. I don’t need to read about it; this is only a distraction and I would contend that it’s potentially detrimental to the care of the patient. We are overloading physicians with reams of notes that are important — but not at all relevant when trying to communicate the crux of a visit. If within the three-page emergency department discharge summary, nestled in the extensively documented physical exam, you mention that you heard a concerning murmur, that finding shouldn’t get the same press as a “chest: clear to auscultation and percussion, no rhonchi rales or wheeze, no increased respiratory effort, and no grunting flaring or retractions.”

I realize that at this point you may be thinking, “Well, there is stuff that needs to be asked, screened and documented.” And I agree. Clearly our roles in health care have changed based on regulations and mandates, and what we need to discuss with patients has changed along with it. We now screen for mental health issues, domestic violence, substance abuse and home/life safety issues, all of which are important. And insurance companies are auditing charts with a closer eye than ever, looking for everything that was covered during the patient exam to justify what was billed. And while I realize I’m a bit of a hypocrite in what I’m about to say, this is exactly where we need to take advantage of electronic health record technology. When an EHR really works, we have the ability to produce both a brief note and a full patient record. Note the emphasis on really.

With a significant part of our job relying on the communication we receive from fellow physicians, we need the ability to easily produce a lean, readable document that communicates three things: 1) what the doctor believes to be the diagnosis, 2) how he/she came to that conclusion and 3) what we are going to do about it. (Sounds a lot like a 3 1/2-inch note card.) Then, in a separate section of the EHR would be all the information that is, essentially, irrelevant for me, but can be made accessible for those requiring the minutia, e.g. insurance companies, lawyers, etc.

So, while we don’t have an option to turn a blind eye to the adoption of electronic records, we can, and should, demand from ourselves and all in our referral networks to produce clear concise communication. And we should continue to push on our EHR vendors for this ability. Let us hold onto the simplicity and clarity — the soul — that a 3 1/2-inch note card gave us.

Scott Moore is a pediatrician and blogs at the athenahealth CloudView Blog, where this article originally appeared.

Prev

Having health insurance is not the same as receiving health care

April 30, 2014 Kevin 10
…
Next

Quality of life: We say it, but do we mean it?

April 30, 2014 Kevin 3
…

Tagged as: Health IT, Pediatrics

Post navigation

< Previous Post
Having health insurance is not the same as receiving health care
Next Post >
Quality of life: We say it, but do we mean it?

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More in Tech

  • Why interoperability is key to achieving the quintuple aim in health care

    Steven Lane, MD
  • How Mark Twain would dismantle today’s flawed medical AI

    Neil Baum, MD and Mark Ibsen, MD
  • 9 domains that will define the future of medical education

    Harvey Castro, MD, MBA
  • Key strategies for smooth EHR transitions in health care

    Sandra Johnson
  • Why flashy AI tools won’t fix health care without real infrastructure

    David Carmouche, MD
  • Why innovation in health care starts with bold thinking

    Miguel Villagra, MD
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 17 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions
    • Why interoperability is key to achieving the quintuple aim in health care

      Steven Lane, MD | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Brevity is the soul of a good EMR note
17 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...