The map is not the territory: medical records and 21st century practice

Martin, Stephen A.; Sinsky, Christine A.

doi:10.1016/s0140-6736(16)00338-x

Cited by 48 publications

(34 citation statements)

References 27 publications

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“…By creating a specific task out of every element of information, even with the use of checklists and reporting by exception, clinicians' time is adversely affected. In part, this is perpetuated by the myth that "if it isn't documented, it wasn't done [11]." Much of this has been driven by linking documentation to payment.…”

Section: Introductionmentioning

confidence: 99%

Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout

Ommaya¹,

Cipriano²,

Hoyt³

et al. 2018

NAM Perspectives

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Section: Introductionmentioning

confidence: 99%

Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout

Ommaya¹,

Cipriano²,

Hoyt³

et al. 2018

NAM Perspectives

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“…The systematic peer assessments done by our College of Physicians and Surgeons of Ontario (CPSO) are based almost exclusively on the assessment of patient records. Importantly, patient records are also currently used for purposes of certification, justifications for payment, auditing, legal action, research, etc., thus jeopardizing their basic function of concisely recording the physician-patient clinical encounter, with repercussions for physicians (who are burned out by excessive demands) and patients 13 .…”

Section: Cad Saúde Pública 2019; 35(j):e00178217mentioning

confidence: 99%

A atenção primária à saúde no Canadá: realidade e desafios atuais

Brandão¹

2019

Cad. Saúde Pública

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Although the discussion refers to Canada as a whole, the provinces have their own health systems, with more or less significant variations between them. Equally relevant is that my perspective comes from working in just two provinces (Quebec and Ontario), specifically in an urban context. Although the Canadian health system is universal, it does not necessarily cover all services. Contrary to Brazil's Unified National Health System-SUS (and its huge limitations notwithstanding), the Canadian system does not generally cover dental care, outpatient medication, or non-medical health professionals (physical therapists, psychologists, speech therapists, etc.). The exceptions vary considerably between the provinces, sometimes with partial coverage for children, older people, post-surgical procedures, "catastrophic" expenditures on medicines (exceeding 4% of the individual's income, for example), low-income individuals, people with disabilities, welfare recipients, etc. The fact that the SUS proposes broader coverage naturally does not mean that the Brazilian system is better, since access to the infrastructure offered by the two countries is on totally different levels. In a recent survey with the sophisticated Healthcare Access and Quality Index, including practically all the countries of the world, Canada ranks in the upper quartile, with Brazil close to the last countries in the second quartile 1. Here in Canada there is practically no private health care model as we know it in Brazil. The existing legal understanding is that the state should be the provider. The majority of Canadians would simply repudiate the notion that a citizen's purchasing power can give him or her better access to health care. In keeping with the most highly developed health systems, primary health care is the basis for the Canadian model. The key health professional in the Canadian system is the family medicine physician. Nurses with Master's-level training ("nurse practitioners") are starting to represent a certain proportion of primary health care professionals, working directly with the population, with either faceto-face or remote access to a physician. The family physician's work is highly centered on the clinic and focused on the individual, with a varied family perspective (since individuals choose their family medicine physicians, not necessarily all members of the family are seen by the same doctor). Contrary to expectations, interaction with other professionals, except for nurse technicians and administrative employees, takes place in the outpatient setting, essentially through referral and counter-referral. Teamwork is not the rule, although it is pursued by planners and is enjoying important growth. Community work, at least in the big cities, is due more to initiatives by the health professional than

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“…We must be willing to evolve and build partnerships with other disciplinary colleagues, and we must also be careful not to over prioritise either techno-centric or info-centric perspectives in our analyses. Following Martin et al [80], it is important that we reflect on what we are trying to achieve with HIT, as they argue, for example, that medical records currently conceptualised as documentation are 'at risk of over-taking the delivery of care in terms of time, clinician focus, and perceived importance'. They go on to argue that 'complete and verbatim documented accounts of any clinical encounter is not desirable and potentially harmful' to the aim of aiding cognition, communication, and care delivery that build relationships and support decision-making -we must aspire to make sure HIT is not just usable and safe but that it is of value to the primary goal of better care!…”

Section: Conclusion: It's the Journey Not The Destination That Mattersmentioning

confidence: 99%

Are We There Yet? Human Factors Knowledge and Health Information Technology – the Challenges of Implementation and Impact

Turner¹,

Kushniruk²,

Nohr³

2017

Yearb Med Inform

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SummaryObjective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT.Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technologyinduced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement. KeywordsHuman factors engineering; usability; patient safety; health information technology Yearb Med Inform 2017:84-91 http://dx

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The map is not the territory: medical records and 21st century practice

Cited by 48 publications

References 27 publications

Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout

Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout

A atenção primária à saúde no Canadá: realidade e desafios atuais

Are We There Yet? Human Factors Knowledge and Health Information Technology – the Challenges of Implementation and Impact

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