Bring back the Narrative

Chad Hiner, RN, MS, Executive Director, Healthcare Healthcare Leave a Comment

“Without a narrative portion in my note, I cannot describe my clinical findings in a meaningful way.”

This is what my PCP told me when I inquired about her new EHR. They had just replaced their old EHR with a new “Off-the-shelf” product, meaning - there was very little done in the way of workflow customization. She went on to say that she is being forced to choose from a drop-down list when documenting a physical exam and that when she goes back to review her previous note, she doesn’t find any useful information contained within it. She was visibly bothered by the fact that she no longer had control of what information was being entered into the patient’s record.

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Chad Hiner, RN, MS, Executive Director, Healthcare


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As a Clinical Informaticist I thought, “information”, wow, she used to enter information into a patient’s record and now she feels like she is simply entering “data”. As I pondered this concept, I realized that what we have gained with EHR’s when it comes to billing, clinical alerts, clinical decision support and patient safety, we have lost in communicating relevant, patient-centric, clinical information.

Beyond the manual data entry burden, she described her EHR as hampering rather than facilitating clinical workflow. Now, this may have more to do with the implementation, the training and the workflow analysis that went into the “Go-Live”, but it was evident that her efficiency had not improved, the 40-minute delay in seeing her was the first clue.

As we look towards a more patient-centric model in healthcare with quality and value being emphasized over the outdated fee-for-service model, we must support clinicians in the ability to communicate. The narrative portion of a clinical note tells the “patient story”, this cannot and should not be replaced with picklists and drop-down menus.

Chad Hiner RN, MS
Executive Director, Healthcare
nVoq, Inc.

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