81–90 of 206 posts
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I dissagree. If I have some sensitive medical history and I go in for stitches or some other minor thing with an random doctor I might not want to share all my medical history. It’s my history and I should have the right to control who sees it.
You are not a medical professional and the list of medical procedures or remedies that interact poorly with each other is long and full of unexpected things.
My favourite citation from the link: “In fact, across this same EHR, clinical notes in the United States are nearly 4 times longer on average than those in other countries” It seems that the EHR isn’t the root cause of the problem.
I think there is also a general misunderstanding of "the note" in an EHR context. The progress note is really just one aspect of a provider's documentation of a visit. Things like medications and allergies are generally indicated as "reviewed" elsewhere in the chart and yet all of this information is many times also entered into the progress note unnecessarily adding to note bloat. In the days of the paper chart the progress note ended up being the only summary of the visit and even though it's now just one piece of the visit documentation, it's still written as though it will be the only source of truth.
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In my experience, it's a combination of a couple of things. First off, the field is heavily regulated (in the US anyway) and the penalties for violating regulations like HIPAA are incredibly high. Second, the field is currently dominated by major players such as Epic, so its pretty important to be compatible with them, but they don't really have an incentive to open up their ecosystem since they have such a strangleh…
The Epic ecosystem is actually pretty open now. They have multiple web service APIs with full documentation, and even provide a developer sandbox you can use to test client applications. https://open.epic.com/ Epic also has an app store. You can write your own SMART on FHIR apps, then deploy them inside the EHR with full access to patient data. https://apporchard.epic.com/
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I disagree on this stance. If you were diagnosed with depression when 13 but no longer depressed its nobody not the doctor, the nurse, the IT staff jobs to know this unless you choose. You have everything from Psychology/Psychiatry notes to overdose records that many health staff can pull up from almost any computer. EDIT: Remember many jobs disqualify you from the job if you have any past psychiatric treatment. Even…
It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…
EDIT: left original link tried to clarify.
[0]: "I drive 300 miles to seek care and always pay in cash." http://www.idealmedicalcare.org/75-med-students-antidepressa...
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You are not a medical professional and the list of medical procedures or remedies that interact poorly with each other is long and full of unexpected things.
Your profession should not dictate your rights to your data.
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It absolutely 100% is at least the doctor’s job to know this. If you come back with depression again, the doctor needs to know what medications were used last time to treat you this time. They need to know if you had allergic reactions, no response, or other details regarding your medication history. The doctor may also be able to use a history of depression as a supporting factor for a new diagnosis. Your history of…
I have friends disqualified from legitimate jobs after taking Psych drugs from decades ago. Somehow I think there needs to be a line. Doctors have known the way around the system for quite a while.[0] EDIT: left original link tried to clarify. [0]: "I drive 300 miles to seek care and always pay in cash." http://www.idealmedicalcare.org/75-med-students-antidepressa...
It is also completely off-topic.
- Doctor enters your visit (encounter), cross your fingers that his system has the most up-to-date medical codes (e.g. snomed, cpt, icd, etc)
- Doctors notes for that encounter are potentially entered as a text area in one system (u/petermcneeley). Can be notes at the encounter level or for a specific diagnosis/lab result/etc.
- The codes vs free text, is what we refer to as discreet and narrative/free text.
- The current IHE spec. [2] (last updated in 2015?), allows for codes to be interpreted from narrative text if a valid code is not provided. I think there are a few startups that have popped up here that are trying to make sense of the narrative text.
- That same spec would be great if everyone followed it but they have to get their system to bend a little bit or throw an integration engine in front of the problem to play nicely with others. (u/nradov)
- Start sending those back and forth and you either end up losing those notes or butchering them up.
- There are some orgs (e.g. DoD, VA, Sequoia, etc) that have everyone follow the basic requirements but then add their own flavor on top. [3]
- FHIR [4] is here, but I think everyone is already scrambling or haven't had the need to make the cut over to it until its government mandated. I have to say this has been the easiest spec. to grok, but it is still way too flexible for these companies to mess up. A cut over to FHIR for everyone should ideally be that you have to use the Hapi FHIR models [5]. Maybe have a way for Hapi to sign the models on their way out?
[1] https://media1.tenor.com/images/af0c71048d5a130cefc335423c59...
[2] http://www.hl7.org/implement/standards/product_brief.cfm?pro...
This makes machine learning using the notes difficult since the content is so muddied up. It's far from impossible to do useful things with them but there is a lot of noise. Still, some things require us to look at the notes. For these things we would much rather have them than not.
While it's preferred to have the information entered in a structured way, doctors find that more of a hassle than entering in the data free-text and it's also no good for retrospective analysis where we didn't know several years ago we would be interested in something and so no structured field existed.
Medicine seems like a technological wasteland. They put "notes" into text boxes and call it "using computers". I wish I had both CS/SE experience and Medical experience so that I could understand what keeps this field in the 1970s. I have suspicions.
