Create the patient narrative: Using technology to make care more meaningful

Sixty-nine-year old Lawrence Dawes felt ill after a long, hot day in the sun at an outdoor concert. His primary care physician, Brian Yeaman, MD,  chief executive officer of Coordinated Care Oklahoma, a health information exchange, suspected Mr. Dawson may have suffered a heat stroke, but turned to his EHR for more information.

The following content is sponsored by Nuance Communications. 

"I'm cruising through his EHR and I see a cutaneous malignant melanoma from 2012," Dr. Yeaman says. "I asked him if that was right. When he said it was, I said, 'Why didn't you tell me that?'"

Mr. Dawson, it turns out, was fine. His ailment wasn't linked to the melanoma he'd had removed earlier. But Dr. Yeaman may never have known about it had he not scrolled past it in the EHR. "As a physician,” Dr. Yeaman says, "you don't know what you don't know, and patients don't always know what to tell you. It's difficult for some to keep track of which medications they took when, their past diagnoses, or information they received from four or five different providers.”

"Unless our systems are interoperable, and sharing the right data in the right place at the right time, it's really a challenge to know the full picture of what's going on with a patient," Dr. Yeaman says. "It's a monkey on our back right now — how do we bridge that gap?"

A picture is still worth a thousand words
The key may be to use new tools to get back to a more traditional tenet of caring for patients: telling a story.

"If you don't tell a story, there's no meaning behind it, it's like trying to treat a patient with big data alone," Dr. Yeaman says. EHRs don't do the best job of crafting a narrative from raw information about patients. In fact, healthcare professionals can easily start to feel like they're fighting for air in a data deluge. To make accurate diagnoses, providers need to know what other providers were thinking when they made a treatment plan.

Providers will only attain necessary improvements in care and patient outcomes with the right tools to access, analyze and arrange patient data in a meaningful way. But today, many are stuck wading through so much patient information that is uncategorized, unstandardized and stored in different places, that it ends up being relatively meaningless, Dr. Yeaman says. "But there are tools providers can use on the front and back end to change that."

"The best tool to get the patient narrative," Dr. Yeaman says, "is one of the oldest — dictation."

Technology to make storytelling simpler
In an ideal world, EHRs would make telling a patient's story a simple, concise process. But the need to check boxes and code and classify information make crafting a narrative feel far from natural. "Dictation, via an EHR-compatible tool like Nuance Communications' Dragon Medical, can humanize digital content,” Dr. Yeaman says. "Nuance offers provider-oriented solutions for establishing a common means of not only capturing a patient's story in the most efficient way possible, but sharing that story with other providers in an interoperable fashion."

Highlighting critical points in a physician's thought process can avert confusion and improve communication — for both patients reading their own records and physicians reading records created by their colleagues or other health care organizations.

"I can't tell you how many of my own typed notes I've gone back to where I don't understand what I was thinking at the time," Dr. Yeaman says. "When I use Dragon I'll say more, because I can say it fast and it's a better flow. I capture more of my thought process and I'm less distracted."

"By combining higher quality dictation with the coding recognition tools built into Dragon Medical, physicians can achieve greater specificity," Dr. Yeaman says. "Many healthcare professionals who are still playing catch up with ICD-10 can alleviate some of that stress by using technology to improve reporting."

"When a physician can tell a story better, their notes are richer," Dr. Yeaman says. "It impacts satisfaction, too. Patients often read their notes, and when they feel they're heard it makes a big difference. Even if the interaction with the provider directly wasn't great, they can see their story in the notes and they realize that you're talking about them."

Using dictation for improved note taking also has a significant impact on efficiency. Dr. Yeaman says the physicians he has introduced to Dragon notice significantly fewer instances where nurses check back with them for prior approval, while also simplifying the note taking process.

A new solution, Dragon Medical One, also enables clinicians to dictate their notes on the go, in the car or at home, rather than having to be tied to a single office-based computer. "We need to create an experience for doctors that allow them to move and to flow and see more patients," Dr. Yeaman says.

Filling in the gaps
According to Dr. Yeaman, many organizations are handcuffing physicians to their computers by asking them to use onerous technology that merely aggregates patient data and doesn't offer the capability to compose meaningful patient stories.

Sometimes, Dr. Yeaman says, providers can be resistant to change, especially when it comes to new technology. But when clinicians see that a tool actually works by making care delivery easier, improving outcomes, and streamlining workflow, it has a huge impact. Additionally, a simple change, such as implementing Dragon in an ER setting, can not only radically improve provider satisfaction, but can save millions of dollars in transcription fees.  

"I look at Nuance as a way to improve EHR workflow and fill in some of the gaps in the provider experience," Dr. Yeaman says. "I can get decision support, while doing real-time dictation, bringing in outside data and minimizing the amount of software solutions being used."

 

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