What to Expect
How will this impact ED practice? There will probably be a period this spring during which we quickly adjust our style of writing notes. How much of an adjustment will depend on your current habits and the fraction of patients who are likely to access the portal or make edit requests. Primary care physicians were motivated to edit their notes to address patient requests; ED and inpatient health care workers don’t have an ongoing relationship with most patients and may not agree with requests nor see the upside in complying. What this means for liability or patient satisfaction is an open question.
Explore This IssueACEP Now: Vol 40 – No 03 – March 2021
The Future of Note Sharing
Beyond digitally sharing notes, there are other milestones related to 21st Century Cures coming up. In 2022, EHRs will make application programming interfaces (APIs) available to patients to facilitate selected data sharing with third parties. We anticipate that services will pop up to “translate” notes and interpret data for patients; APIs will also enable patients to integrate their data with an emergency department’s EHR.
Beyond that, trials are under way for OurNotes a system that encourages patients to formally contribute to their medical records. This would allow patients to generate part or all of the history, which is then reviewed by the physician before being accepted as part of the medical record. As with many things in health information technology, the details of the implementation will determine whether this is a helpful time-saver or a step toward bloated, inaccurate notes.
For now, we anticipate that ED patients with portal access will understand more from their visit, helping patients, families, and downstream clinicians understand what occurred during an emergency department visit, the relevant medical decision making, and after-care expectations. Hopefully the trade-off of writing clearer notes and fielding some more edit requests will prove easy enough to make it worthwhile for the patient’s benefit
Tips to Limit Patient Misinterpretation
Patients react poorly to terms like “morbidly obese,” “complains of,” and “bounceback.” Alternatives like “BMI >40,” “presents with,” and “revisit” are less likely to prompt complaints or edit requests. Stylistic writing tics taught in medical school such as “patient endorses” or “patient admits to” might confuse patients or worse. Terms such as “sickler” for sickle cell anemia patients and even “vasculopath” for patients with coronary or peripheral artery disease can easily be interpreted as dismissive or reductive and should specifically be avoided.
If a patient says something remarkable, use quotations to describe it rather than a glib summary.
Limit usage of contact information in the chart that the patient should not directly have access to, such as consultant’s phone numbers.
Be careful with your macros and dot-phrases—it looks careless when atrial fibrillation patients read that their cardiovascular examination found a “regular rate and rhythm” or amputees read about “well-perfused extremities bilaterally.”
On the bright side, dot-phrases can help you spell out confusing abbreviations or explain arcane terms.
The sharing options in the EHR should be unselected if there are safety or privacy concerns (eg, if the notes have sensitive material that the patient doesn’t want seen by a domestic partner or parent).