Monday, July 23, 2007

Graphical Summary of Patient Status


Sent to you by Judi via Google Reader:


via On Informatics by David Dorr on Jul 21, 2006

Recently, I (re)discovered this gem of an article:

Powsner SM, Tufte ER. Related Articles, Links
No abstract Graphical summary of patient status.
Lancet. 1994 Aug 6;344(8919):386-9. No abstract available.
PMID: 7914312 [PubMed - indexed for MEDLINE]

Graphical summary of patient statusOne enormous difficulty in the care of complex patients - in this case, hospitalized patients - is the sheer volume of information that is generated over relatively short amounts of time. One of the key requests seen by EHR developers in these settings (whether 'home-grown' or vended) is to better summarize the data. This has led to many different solutions in the area, from flexible flowsheets (think excel worksheets) to 'rounds reports' (single page summaries of key information usable as the health care team goes on rounds) to snapshots (special pages in the EHR that attempt to summarize various aspects of health or care).

For those familiar with the use of EHRs, all of the above examples likely ring a bell. In my experience, these components are often the value-added aspects of the EHR for resident physicians and students in academic centers - the ability to have, easily at hand, a wealth of knowledge about patient status. Interestingly (and, I admit, anecdotally), these summaries are often printed. We created such a summary sheet (available for view here) and found use was higher when printed and placed on the door prior to a visit. The physician or nurse, typing madly into the EHR, would refer to various aspects when making orders or creating notes, alleviating the need to ask the system to flip back and forth between old data and new entries. The sheet provided a lot of pertinent information about specific aspects of a patient's health in a simple format. The major complaint was still the amount of data one needed to sift through.

Tufte and Powsner take this to the next level, by summarizing dozens of variables, adding important context (what matters often is not an absolute level but recent trends and long-term status - what is normal for this patient), and leaving the text at the side. A few groups attempted to take this concept and move forward with it, but they aren't in wide use. It seems like a gem of an idea. Patient records should be easily carried with the team, contain a wealth of information very simply presented, and remove all of the distracting numbers in favor of relative thresholds. Especially interesting is the summary variable for psychosis - quantitative measures for most mental illnesses have been developed but, again, slow to catch on.

Although I have an idea why we haven't implemented these functions broadly (I am being overly positive about the idea on purpose), I'd be interested in the now and future readers' comments. Does this concept work? How could we improve upon it? If you think it can't be successful, why? What other methods appeal to you?


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