Colin Kopes-Kerr, MD
5989 Vista Ridge
Santa Rosa CA 95409
E-mail: cpkerr@nni.com
Kopes-eticHealth.com:
A New Dawn for Health Care Information
1. The Ultimate Progress Note to Reduce All-cause Mortality
Rationale: The design of this routine progress
note is intended to allowed the practitioner to attend effortlessly to the major
determinants of positive health outcomes--CAD Risk Assessment, Lifestyle
modification, and general screening and prevention.
It is also intended to save physician time by having so many
pieces of documentation accomplished by just a check-mark. It also saves time by
allowing many elements of the physical exam to be done by observation alone.
It is also intended to make coding for Medicare easier by
incorporating the billing elements of "new" vs. "established", "stable" vs.
"worsening" into your overall assessment to that billing at a 99103 or 99104
level should be obvious.
But the most important overall point of the design is to
ensure that the highest priorities in health care get thought about on every
single visit by having a visible prompt to do the important stuff on every
single note.
2. Concept Mapping in the Progress Note:
The following illustrations of potential designs for a progress
note attempt to incorporate the concepts of Mind-Mapping, a visual thinking
technique that more closely reflects nature's architecture and neural
anatomy--the principle of radiant-thinking. The fundamental concept is that
humans think better when working with images, and that the most efficient way to
characterize and record features of these images is by means of radiant spokes
from each central image. The advantage this has over conventional linear
text-based charting is that it keeps the most important elements of care in
focus. The 3 fundamental purposes of each visit jump out at you at each glance.
Contrast this to the usual text-writing from left to right then down, whereby as
soon as you have finished with the first problem you've forgotten about it, and
can no longer readily see it in your note; the only element that really sticks
in your mind is what you wrote last.
In the examples that follow it is assumed that each standard
office visit should focus on 3 and only 3 aspects of care. To do less is to
waste a relatively rare opportunity when a patient is seeking direct help. To do
more is to lose track of all important details and thus to accomplish nothing.
Each of the 3 major circles in each diagram should be characterized by no more
than 7 elements (since that is all the average human mind can grasp). This is an
easier way to convert your clinical observations into a note and is ultimately
simpler, yet more thorough, to record. It invites a lot of flexibility and
experimentation in both your thinking and recording.
More advanced aspects of mind-mapping (i.e., the use of
varying color, shapes, and sounds) could be magnificently realized with
electronic medical software, if users and designers just free themselves from
the notion than an EMR is just a fancy word-processor or text database. Imagine
if your medical software played a few bars of one of your favorite tunes every
time you clicked to document a preventive medicine action. You just might do it
more often!
The point is that the manner in which conventional medical
visit are conducted tends to turn the mind off or has it just tracking down
complicated lists of prescribed protocols. We could replace this with a system
that makes the writing of each note a creative, artistic act! Try it!
A. The Basic Visit: A minor chief complaint and 2 chronic
problems
B. Alternative Basic Visit:
3 chronic problems with no chief
complaint
C. The Social Problem visit
D. Chief Complaint only visit
3. Preventive Visit Templates:
A. Adults
B. Kids
