... continuing
The Documentation Era:
This has a lot to do with miscommunication, but it deserves a category of its own due to its magnitude and the dysfunctional way it was built into daily clinical practices. Everyone knows how important eye contact when communicating, and we have been taught in Med School how important it’s to talk to your patient without putting barriers between you and them, not even a desk. Nowadays, doctors do exchange good and constant eye contact, but the computer screen, busy typing and clicking while asking the patient for very important and sensitive information, and the poor patient gets only the side profile of the doctor’s face. This shows how much respect there is nowadays between doctors on one side, and patients and their families on another side, and the tiny if any amount of trust and rapport being built. The first step of the healing process!
It’s commonly said that if something was not documented, it’s not done. The reason behind pushing vigorously towards it by many is an attempt to make sure that necessary information are available and accessible anytime, for better continuum of care, safety, and for medico-legal purposes. It’s clear that healthcare systems have taken the wrong turn on this and lost the essence of the whole value of documentation, to the point that it has become one of the main reasons for broken systems and unsafe practices.
Studies have shown that the national average of nursing time spend at the bedside providing direct care to the patients in the US is less than 50%. Most of the time is spent doing things that adds no direct value to the patient, including documentation. If you have the chance to observe a nurse in an inpatient unit for an extended length of time (the time you are waiting for your doctor, maybe!), you could see the huge amount of time wasted, not in delivering medications, not in assessing patients, not discussing cases or responding to patient and family needs, but in handwriting, typing, punching and stapling, filing and shelving , and getting papers signed or stamped. Nurses who are supposed to be closer to patients more than any healthcare professional have turned into secretaries who are overwhelmed with a great deal of paper or computer work, and the only touch time with patients in one day can be as much as 30 minutes in total!
Documentation is necessary, but over, redundant, and disorganized documentation has become an issue that everyone complains of, and takes providers away from their most important job they signed up for. What went wrong?
One of the clear factors is the requirement of some regulatory and accrediting bodies requiring all sorts of information to be documented in a certain way or format, and in the absence of creative and versatile care systems, or well-educated and smart health informatics professionals, providers have no choice but to comply in the exact way. If you had to choose, provide better care (not medicine) with less documentation, or complete documentation but less care and compassion, which one would you opt for?
Another major issue is in the design and management of popular information systems in the market, many of which are not co-developed with healthcare professionals, never looked at actual care process, and only focused on what the doctor or nurse need to document or view. Even after incorporating all the requirements on a nice looking system, it turns out to be unfriendly and hard to navigate. On the other side, IT professionals managing those systems in a healthcare organization have no clue about the impact of adding one module after another on the care process, and don’t really bother to rethink and integrate documentation requirements when they arise, causing inflation of data in an already broken system..
The Documentation Era:
This has a lot to do with miscommunication, but it deserves a category of its own due to its magnitude and the dysfunctional way it was built into daily clinical practices. Everyone knows how important eye contact when communicating, and we have been taught in Med School how important it’s to talk to your patient without putting barriers between you and them, not even a desk. Nowadays, doctors do exchange good and constant eye contact, but the computer screen, busy typing and clicking while asking the patient for very important and sensitive information, and the poor patient gets only the side profile of the doctor’s face. This shows how much respect there is nowadays between doctors on one side, and patients and their families on another side, and the tiny if any amount of trust and rapport being built. The first step of the healing process!
It’s commonly said that if something was not documented, it’s not done. The reason behind pushing vigorously towards it by many is an attempt to make sure that necessary information are available and accessible anytime, for better continuum of care, safety, and for medico-legal purposes. It’s clear that healthcare systems have taken the wrong turn on this and lost the essence of the whole value of documentation, to the point that it has become one of the main reasons for broken systems and unsafe practices.
Studies have shown that the national average of nursing time spend at the bedside providing direct care to the patients in the US is less than 50%. Most of the time is spent doing things that adds no direct value to the patient, including documentation. If you have the chance to observe a nurse in an inpatient unit for an extended length of time (the time you are waiting for your doctor, maybe!), you could see the huge amount of time wasted, not in delivering medications, not in assessing patients, not discussing cases or responding to patient and family needs, but in handwriting, typing, punching and stapling, filing and shelving , and getting papers signed or stamped. Nurses who are supposed to be closer to patients more than any healthcare professional have turned into secretaries who are overwhelmed with a great deal of paper or computer work, and the only touch time with patients in one day can be as much as 30 minutes in total!
Documentation is necessary, but over, redundant, and disorganized documentation has become an issue that everyone complains of, and takes providers away from their most important job they signed up for. What went wrong?
One of the clear factors is the requirement of some regulatory and accrediting bodies requiring all sorts of information to be documented in a certain way or format, and in the absence of creative and versatile care systems, or well-educated and smart health informatics professionals, providers have no choice but to comply in the exact way. If you had to choose, provide better care (not medicine) with less documentation, or complete documentation but less care and compassion, which one would you opt for?
Another major issue is in the design and management of popular information systems in the market, many of which are not co-developed with healthcare professionals, never looked at actual care process, and only focused on what the doctor or nurse need to document or view. Even after incorporating all the requirements on a nice looking system, it turns out to be unfriendly and hard to navigate. On the other side, IT professionals managing those systems in a healthcare organization have no clue about the impact of adding one module after another on the care process, and don’t really bother to rethink and integrate documentation requirements when they arise, causing inflation of data in an already broken system..
to be continued ...
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