Ehr – Checklists & Bayesian Diagnosis

A really interesting recent article past times Shiff together with Bates published inwards NEJM proposes a rather ambitious create goodness for EHRs.
The article aptly titled “Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?” together with aptly presented every bit a query rather than a statement, is exploring the possibility that EHRs tin trim down diagnosis errors. The authors duly acknowledge that in that place isn’t much evidence to back upwardly such frontwards thinking for the electrical flow crop of EHRs.

“Admittedly, evidence to back upwardly the beingness of such a create goodness is currently lacking, together with our hypothesis runs counter to the sentiments together with claims of many physicians, who debate that electronic documentation inwards its electrical flow incarnation is time-consuming together with tin degrade diagnostic thinking — past times distracting physicians from the patient, discouraging independent information gathering together with assessment, together with perpetuating errors.”

However, they are envisioning a novel breed of electronic documentation that volition endure capable of fulfilling such lofty goal. Most of the proposed characteristics of this novel generation of software are incremental improvements to collection together with presentation of information from diverse sources. This is inwards work alongside the national goals of fostering interoperability together with the creation of an Electronic Medical Record for every American past times 2014. Computerization is also viewed every bit a solution for the introduction of mechanical errors due generally to miserable handwriting together with miserable newspaper based mass keeping, such every bit the create goodness provided past times electronic prescribing. All inwards all, the authors’ suggested “top 10” mode listing of desired improvements to EHR technologies are really sensible together with accept the potential to amend usability, collaboration together with effectiveness.

An interesting aside is that the authors suggest to a greater extent than textual information capture together with to a greater extent than reliance on vox recognition every bit opposed to discrete information capture past times “ticking boxes”. I promise the authors empathize that dictation together with gratis text create non lend themselves really good to “aggregation, trending, together with selective emphasis or display of information together with then every bit to facilitate rapid judgments”, which are the cornerstone of the approach suggested inwards the article.

Influenza A virus subtype H5N1 to a greater extent than interesting proposition is the usage of Checklists for “Providing prompts”:
“Provide checklists to minimize reliance on retention together with directed questioning to assistance inwards diagnostic thoroughness together with work solving”

And to popular off alongside the checklists in that place is “Calculating Bayesian probabilities”:
“Embed estimator into notes to trim down errors together with minimize biases inwards subjective estimation of diagnostic probabilities”.

This, of course of written report is the thought that determination back upwardly at the indicate of attention has to popular off powerful plenty to alter the imperfect means medicine is adept today.

“But nosotros envision a redesigned documentation purpose that anticipates novel approaches to improving diagnosis, non ane that relies on the putative “master diagnosticians” of past times eras. The diagnostic procedure must endure made reliable, non heroic, together with electronic documentation volition endure fundamental to this effort.”

The query inwards my heed is at what indicate does determination back upwardly popular off every bit good powerful together with begins crippling both physicians together with character of care? And is in that place such a point?

For an thought on this subject, I suggest Dr. Jerome Groopman’s fantabulous mass “How Doctors Think”.