By HANS DUVEFELT
The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions is necessary to document and review when following a patient through their treatment.
In the old paper charts, particularly when they were handwritten, office notes, phone calls, refills and many other things were displayed in the order they happened (usually reverse chronological order). This made following the treatment of a case effortless, for example:
3/1 OFFICE VISIT: ?UTI (where ciprofloxacin was prescribed and culture sent off)
3/3 Clinical note that the culture came back, bacteria resistant and treatment changed to sulfonamide.
3/5 Phone call: Patient developed a rash, quick handwritten addition on left side of chart folder, sulfa allergy. New prescription for nitrofurantoin.
3/8 Phone call: Now has yeast infection, prescribed fluconazole.
Each of these notes took virtually no time to create and you could see them all in one glance.
In one of the EMRs I work with (hi, Greenway, it’s me again), when the culture comes back and I need to change the antibiotic, I open the patient’s chart, go to the medication section and hit the + sign. The system then asks me which existing “encounter” I want to use for my new prescription. Excuse me, I am sending in a new prescription right now, doesn’t the system know what day it is? How could I today send in a new prescription dated yesterday?? So I have to create a new encounter, choosing “medication encounter” as the type and then I’m good to go. Sort of. That type of encounter doesn’t display when I later look at my office notes, because it isn’t classified as an office note.
When the patient later calls to report the rash, that telephone call comes to me as a “task” (oh, how I despise that demeaning