Patients are more connected to their care than ever before and are empowered to access information, such as clinical notes.

They are now the top users of the NYU Langone Health's electronic health record, something Nader Mherabi, NYU Langone Health's chief digital and information officer, frequently points out.

And, as Dr. Jonah Feldman, medical director of clinical transformation and chief transformation officer for NYU Langone Hospital Long Island Hospital explained, when it comes to efforts to improve note quality and reduce bloat, no coalescence of key stakeholders can occur without patients.

"Our best practice is what we as clinicians know well – to listen to all the data streams paying attention to the sources – particularly clinicians and users," said Feldman. "Finally, the usual facilitators or blockers should be identified to amplify or mitigate."

Feldman, who will address the topic this month at HIMSS22, said good organizational governance is foundational to ensure that diverse stakeholders come together around core principles and define measures of success.

"You could have the best technology in the world, but without broad agreement about what constitutes a great note, great care and great communications, improvement efforts are doomed," he explained.

By linking out to best-practice data visualizations from within each template section, the organization experienced a 50% reduction in progress note length.

Clinical decision support within provider notes also helped promote discharge and contingency planning, leading to measured improvement in note quality.

"We succeeded by reframing the view of notes – from buckets of data to thoughtful synthesis that transforms information into knowledge and wisdom," Feldman said. "This change in mindset allowed us to eliminate the large uncontextualized text tables and copied forward reports that have historically flowed into note templates."

Instead, hyperlinks inside notes link out to best practice data visualizations that support critical thinking, and dynamic displays embedded within note templates guide authors to comment purposefully on the most relevant clinical findings.

In addition, inline clinical decision support nudges encourage more thoughtful clinical assessment and decision-making.

Feldman also pointed out future planning is essential for clinicians, but inpatient notes often lack this vital element.

He explained adding a discharge milestones and contingency planning note section to the end of the SOAP note structure helped ensure that this part of care was more reliably addressed.

The section contains hyperlinks to discharge-specific information displays and activities where the multidisciplinary team can identify an expected discharge date, document disposition, barriers, and post-discharge needs.

"In addition, inline clinical decision support nudges guide physicians to address medical milestones for discharge, including change from IV to PO antibiotics, anticoagulation transitions, and pain management assessment and planning," he said.

Dr. Feldman will explain more in his HIMSS22 session, "Improving Quality and Reducing Bloat in Physician Notes." It's scheduled for Wednesday, March 16,  from 10-11 a.m. in room W311A.

Nathan Eddy is a healthcare and technology freelancer based in Berlin.
Email the writer: nathaneddy@gmail.com
Twitter: @dropdeaded209