Do you remember the big crystal ball in the original Wizard of Oz? As a kid I remember daydreaming about what I could foresee if I possessed the magical ball.
I haven’t seen “Oz: The Great and Powerful” yet but I anticipate that today’s special effects offer a crystal ball with a clearer, more defined picture of the future. I’d like to peer into this spherical wonderland for a glimpse of how a physician will deliver patient information upon the full adoption of Meaningful Use Stage 2.
Will the image portray a doctor dictating narrative or will we see and hear the repetitive click of a mouse placing scripted data into the EHR?
In the final scene I think we’ll see a compromise of templates and narrative. Clearly there are sections of the EHR that create efficiencies for predefined entry. Other areas within the EHR may not lend themselves to clicking through templates.
But to capture an accurate patient encounter the EHR must increase the opportunity for dictation. I mention the patient encounter first in this argument as a reminder that patient safety and improved outcomes are the ultimate drivers in the evolving electronic health record.
There are many other drivers necessitating the need to open the EHR to more dictation. Physicians are struggling to accurately capture the patients’ stories within the stamped text contained in a template. Consider for a moment that you’re a reporter assigned to cover the Super Bowl but you can only use predetermined snippets of information to convey to your readers the essence of the game. Physicians feel the same handcuffed limitations as they are locked into canned text.
Then there’s the issue of effective physician time management. I’m still amazed that the top revenue generators in healthcare are pigeon-holed into inefficient processes. For a doctor, a disruption or distraction of a millisecond costs precious and valuable time and money.
The shift to ICD-10 opens up another discussion. The complexities of the codes will require the provider to expand their documentation of the patient’s symptoms and diagnoses. The limitations of templates and the increased number of codes will increase the need for narrative.
As the debate continues between templates and dictation sometimes it might seem easier to click our ruby slippers and magically appear back in Kansas with everything just like it was when we left. But like Warner Brothers, producers of the “The Wizard of Oz,” and Disney who produced “Oz: The Great and Powerful,” there has been controversy and a rivalry of ownership. They are fighting over words and ownership.
The difference – this isn’t Hollywood. Patients’ lives literally lie in the balance. As participants in the progression of healthcare let’s rally together, put our differences aside, reach across the table and achieve meaningful patient care and medical records that provide data that propels patient diagnoses and changes peoples’ lives.
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