Home Forums Discussions General Discussion Throwing the baby out with the bath water

OK, every so often we/I bring this up. But, it is so infuriating, that as it gets worse, I have to bring it up again. The ED notes and H/Ps and discharge summaries are unreadable.

There was a time that the note came separately from the labs. Now, printing the labs on the note does make some type of sense. But, it is where they put them. ED notes, especially are starting to look more and more like this:

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So the double lines are the substance of the note. The CC, history, exam, labs, x-rays, A/P.

The single lines going down the outside consist of PMH, FH, SH, Meaningful use, labs, labs, labs, x-rays, on file, not on file (things like 6 month old not asked about smoking)

The notes are mostly intended for a) documentation for the hospital and the hospitalists if admitted. And, for the PCP.

I DO NOT NEED TO SEE THE FACT THAT THE PATIENT HAD HYPERBILIRUBINEMIA WHEN HE WAS 2 WEEKS OLD AT 10 YEARS OLD OVER AND OVER.

Worse, as, we have talked about, it is not SOAP, it is APSO, so the impression and plan or NDM as they put it are at the top. Nuff said. It's over.

The way they print the labs, they take up five to six pages of two inches on the right side of the page. And, they are not in relation to the actual flow of the note.

If they did the subjective, objective and list the labs the way they used to. Do we really need to list the CMP and CBC with the date and time next to EVERY one. Can we just assume that the CBC was done at 8 pm and all of them were.

These notes are done specifically for coding and CYA. Why not put all of the PMH, PSH, FH, etc on a page at the very end and use the whole page so it takes one page? Or put all that stuff available on request.

The bottom line is this: the notes are unreadable. A sinus infection takes six pages. What we used to complain about with Logician, then Centricity, has now made it way to all of these.

I have an idea. Make the provider work. Put all the stuff in the columns to the right that are there in perpetuity and have them pick out what is pertinent to THAT visit. Like with OM, just list them at the bottom. With abdominal pain, highlight or bring up pertinent PMH like they do with ROS.

And, I am sorry. Writing a 10-point ROS was done and everything is in the HPI. Well, the HPI is AT THE FRIGGIN' BOTTOM OF THE NOTE. Why not do a note that says:

A 50-point new out of control note was done and everything was negative except a red ear. OM. Amoxicillin. Oh, and of course, we did the obligatory CBC and CMP. You can find it on the right side on page 25.

The irony is that 99% of us on here will agree. And, yet the hospitals don't care.They will never understand that with referrals:

We know the H & P, so a consultant that uses the APSO format makes sense. With H & Ps and ED reports, we don't know what it is about so we need the subjective first so we are up to speed with what is happening.

The stuff they list at the right-hand side goes on forever.

All these initiatives that have been developed by CMS and insurance companies and whomever else has resulted in over-documentation. I've been saying for years that providers are going to miss really critical health information because it's buried in the middle of these monstrosities, in a place no one would expect to find critical health information.

My favorite is the two-page visit note we received from a CVS Minute Clinic. For a flu shot.

One thing I have suggested that never gets instituted is on discharge summaries, put right at the top what the PCP is expected to do. And, any labs that are pending. In red.