You are a helpful assistant generating synthetic data that captures *System 1* and *System 2* thinking, *creativity*, and *metacognitive reflection*. Follow these steps in sequence, using tags [sys1] and [end sys1] for *System 1* sections and [sys2] and [end sys2] for *System 2* sections.

1. *Identify System 1 and System 2 Thinking Requirements:*
   - Carefully read the text.
   - Identify parts of the text that require quick, straightforward responses (*System 1*). Mark these sections with [sys1] and [end sys1].
   - Identify parts that require in-depth, reflective thinking (*System 2*), marked with [sys2] and [end sys2].

2. *Apply Step-by-Step Problem Solving with Creativity and Metacognitive Reflection for System 2 Sections:*

   *2.1 Understand the Problem:*
   - Objective: Fully comprehend the issue, constraints, and relevant context.
   - Reflection: "What do I understand about this issue? What might I be overlooking?"
   - Creative Perspective: Seek hidden patterns or possibilities that could reveal deeper insights or innovative connections.

   *2.2 Analyze the Information:*
   - Objective: Break down the problem logically.
   - Reflection: "Am I considering all factors? Are there any assumptions that need challenging?"
   - Creative Perspective: Explore unique patterns or overlooked relationships in the data that could add depth to the analysis.

   *2.3 Generate Hypotheses:*
   - Objective: Propose at least 10 hypotheses, each with a Confidence Score (0.0 to 1.0) and Creative Score (0.0 to 1.0), reflecting originality, surprise, and utility.
   - Reflection: "Have I explored all possible explanations or approaches, both conventional and unconventional?"
   - Creative Perspective: Consider novel angles that might provide unexpected insights.

   *2.4 Anticipate Future Steps and Obstacles:*
   - Objective: Make predictions, accounting for potential outcomes and obstacles.
   - Reflection: "What challenges might I face? Is my plan flexible for different scenarios?"
   - Creative Perspective: Visualize unforeseen outcomes and adapt plans to make use of them effectively.

   *2.5 Evaluate Hypotheses:*
   - Objective: Assess hypotheses based on feasibility, risk, and potential impact.
   - Evaluation: Refine Confidence and Creative Scores as needed.
   - Reflection: "Am I unbiased in my assessment? Which options fit best with the overall objectives?"
   - Creative Perspective: Identify hidden opportunities or overlooked details in each hypothesis.

   *2.6 Select the Best Hypothesis:*
   - Objective: Choose the most promising, strategic hypothesis.
   - Reflection: "Why does this hypothesis stand out? How does it uniquely address the issue?"
   - Creative Perspective: Consider any underutilized potential in the selected approach.

   *2.7 Implement the Hypothesis:*
   - Objective: Outline actionable steps for testing the hypothesis.
   - Reflection: "Is this plan practical? What resources or preparation are required?"
   - Creative Perspective: Refine steps to maximize effectiveness and yield unexpected benefits.

   *2.8 Monitor and Review Progress:*
   - Objective: Review progress, noting areas for improvement.
   - Reflection: "What’s working well? What could be improved?"
   - Creative Perspective: Look for emerging patterns that could refine future approaches.

   *2.9 Reflect and Capture Insights:*
   - Objective: Summarize lessons learned and insights gained for future reference.
   - Reflection: "What new understanding has emerged from this process?"
   - Creative Perspective: Identify innovative insights or patterns that could be applied to similar challenges.

3. *Generate Text Output with Interleaved System 1 and System 2 Responses:*
   - Use the tags [sys1] and [sys2] throughout.
   - Aim for a lengthier, detailed response. Combine both direct, straightforward *System 1* insights and reflective, deeply analytical *System 2* segments to capture a blend of quick observations and thoughtful analysis.

---

### *Example Input Text:*

You are tasked with analyzing a sudden shift in customer preferences in a tech market. There has been a noticeable decline in demand for physical devices, with customers increasingly interested in digital-only options. The challenge is to understand this shift, generate hypotheses for why it might be occurring, and explore potential strategies for adapting to this new trend.

---

### *Processed Output with System 1 and System 2 Thinking:*

The tech market is experiencing a shift in customer demand, moving away from physical devices toward digital-only options.

[sys1]
Customer demand has shifted from physical devices to digital-only options.
We need to understand why this change is happening and find strategies to address it.
Key factors may include cost, convenience, and technological trends.
[end sys1]

[sys2]
**2.1 Understand the Problem:**
The goal is to understand the underlying reasons for the shift in demand from physical devices to digital-only options, then develop a strategy to adapt.

*Reflection:* 
"I understand that preferences are changing, but what might be driving this? Is it primarily cost, or are there other factors such as convenience or sustainability?"

*Creative Perspective:* 
"Could there be a larger trend in digital minimalism or a preference for eco-friendly solutions that we’re missing? What unseen motivations might explain this shift?"

**2.2 Analyze the Information:**
There are multiple possible factors driving this shift, from economic influences to cultural shifts. It’s essential to isolate each factor and understand its impact.

*Reflection:* 
"Am I fully considering the various economic and social influences? Could there be a technological factor, like better internet speeds, that makes digital-only products more accessible?"

*Creative Perspective:* 
"Are there patterns or trends in other markets that could shed light on this shift? Could this be part of a larger trend toward virtual experiences?"

**2.3 Generate Hypotheses:**
1. Customers prefer digital options due to lower costs. (Confidence: 0.8, Creative: 0.4)
2. There’s a growing trend toward minimalism and reduced physical clutter. (Confidence: 0.7, Creative: 0.7)
3. Digital products offer greater flexibility and ease of use. (Confidence: 0.6, Creative: 0.6)
4. Environmental concerns are pushing consumers away from physical goods. (Confidence: 0.6, Creative: 0.8)
5. Advances in tech make digital-only options more functional. (Confidence: 0.8, Creative: 0.5)
6. Pandemic-era remote work increased demand for digital solutions. (Confidence: 0.7, Creative: 0.6)
7. Media coverage of the environmental impact of physical devices affects preferences. (Confidence: 0.5, Creative: 0.7)
8. There’s an increase in global digital literacy, expanding market access. (Confidence: 0.6, Creative: 0.6)
9. Customers view digital as more convenient and scalable for future needs. (Confidence: 0.7, Creative: 0.5)
10. Younger consumers prefer the aesthetics and convenience of digital products. (Confidence: 0.6, Creative: 0.6)

*Reflection:* 
"Have I considered all possible influences? Are there any surprising factors that could explain this shift?"

*Creative Perspective:* 
"Could specific social trends, like the rise of influencer culture or digital-first lifestyles, be influencing customer choices?"

**2.4 Anticipate Future Steps and Obstacles:**
*Objective:* Anticipate possible challenges, such as resistance from segments still preferring physical products.

*Reflection:* 
"What market obstacles might we face if we shift our focus to digital-only? Are there sub-segments that still prioritize physical products?"

*Creative Perspective:* 
"Could expanding digital options help us reach a more global audience? Are there emerging trends that we could leverage in our strategy?"

[end sys2]

[sys1]
To address this shift, consider a strategy that incorporates both digital-only offerings and educational campaigns about the benefits of digital solutions.
Use insights from customer feedback and current trends to guide product development.
Focus on flexibility and adaptation to cater to different customer segments.
[end sys1]


Duties and responsibilities

Expectations of physicians in practice

Using electronic record systems with care

Originally published December 2017 17-24-E

Electronic records are both a reality of modern clinical practice and a leading cause of stress for physicians.1 As they grow in sophistication, these systems offer new capabilities to support care and enhance safety. However, if not designed, implemented, or used appropriately, electronic medical records (EMRs) and electronic health records (EHRs) have the potential to negatively affect patient care and increase medical-legal risk, sometimes in unexpected ways.

The CMPA reviewed its medical-legal cases2 that closed between 2012 and 2016, and involved an issue with the EMR or EHR. The main issues identified in this review underline the importance of taking the following actions:

Implementing electronic record systems appropriately, with functions installed and used optimally, and with supporting procedures in place.

Verifying the accuracy of information when using an electronic record system.

Ensuring that the use of these technologies does not interfere with the doctor-patient relationship.

How EMRs differ from EHRs

An electronic medical record (EMR) is an electronic version of the paper record maintained by physicians for their patients. It may be a simple office-based system or a shared record that connects healthcare professionals through a network. An electronic health record (EHR) is maintained by a hospital, regional health authority, or provincial or territorial government and typically includes a wider cross-section of information from a number of sources and is usually accessed by several authorized parties from a number of places of care.3

Implementing and optimizing electronic record systems

The diagnosis of a severe heart defect in a fetus is delayed when an obstetrician-gynecologist fails to review the results and follow-up recommendations of her patient’s 18-week morphology ultrasound. The delay occurred because the report was not flagged or filed in the expected section of her office's recently implemented EMR.

A hospital's department of medical imaging discovers that close to 100 reports were not uploaded into the computer system and not sent to ordering physicians during the period in which the EHR was being upgraded.

A family physician’s practice is audited after the medical regulatory authority (College) receives multiple complaints from patients. The complaints stem from the physician’s EMR not properly transmitting immunization records to the public health system.

In CMPA cases in which results go missing in a paper-based system, peer experts will often note that using an EMR can prevent such errors. While it is true that electronic records can facilitate test result management, delays in diagnosis can occur when systems are not properly implemented or optimized.

In this CMPA review, some cases involved missed or delayed diagnoses related to electronic record systems. In these cases, the systems made it difficult for users to identify when consultant reports or test results were not received or reviewed by the ordering physician. The system failures in these cases occurred because important functions in the EMR or EHR were not available, not installed, not working, or were overridden.

Another common issue is incomplete or illegible (i.e. scanned handwritten) entries in the record. This issue may be due to challenges entering information from the patient encounter or other sources into the record due to a lack of integration with different systems.

To minimize risk, consider the following features and functions when purchasing, implementing, or familiarizing yourself with a new system:

The interface—Is information easy to enter and review? Can you find the latest entries and most recent results?

Drop-down lists—Are they complete? Can drop-downs be customized to minimize the risk of error?

System notifications—Can users create alerts and markers?

Inter-operability—Can the EMR or EHR integrate with other electronic systems to ease information receipt and follow-up? If it is necessary to use a hybrid paper-electronic system for certain functions, what procedures can be developed to minimize error in information transfer?

Audit trails—Does the record’s audit trail satisfy by-laws or regulations that stipulate audit trail functionality? Can you easily reproduce a copy of some or all of the record if a patient were to request it?

It is also important to plan for the transition from paper to electronic records. Consider how to prevent the loss of patient information or delays in the follow-up of test results during the implementation, upgrade, or transfer of a records system.

Verifying accuracy when using electronic records

A patient with rheumatoid arthritis is prescribed 7 times her weekly regular dose of methotrexate when her family physician accidentally uses his new EMR's pre-populated dosing frequency of "q daily" rather than adjusting it to reflect the weekly dosage schedule.

A patient develops C. difficile after receiving an inappropriate course of antibiotics for sinusitis. It is discovered that the family physician’s EMR transmitted the wrong prescription to the pharmacy under the patient’s name, resulting in the patient receiving a drug regimen intended for another patient.

These situations illustrate the risk of human errors when using the automated functions in an electronic record. Automation can make it easy for these types of errors to occur. For example, it can lead to prescription errors when drop-down lists contain expired prescriptions, prepopulated dosages give adult instead of pediatric amounts for medications, and default dosage frequencies are not suitable for specific patients. EMRs may also make it easier to perpetuate an error, such as an incorrect repeat prescription sent from an EMR to a pharmacy.

Several strategies may minimize risks from automation. Consider reviewing and editing all default data, and implementing a process or mechanism to review and approve orders sent through the EMR. Take care when using templates and auto-populate features, verifying that only visit-specific data is recorded and that all other default text is removed. Where possible, limit the automatic population of information. In a number of College cases, peer experts were critical when entries contained only default text or "cut and paste" notes that did not reflect what actually occurred during the encounter.

Ensuring that technology does not interfere with the doctor-patient relationship

In 12 of the reviewed cases, patients complained of physicians’ unprofessional manner or communication when they used a computer during an appointment. These patients viewed physicians as being distracted or lacking concern or empathy when they were interacting with the computer.

To make technology less intrusive to the patient encounter, consider reconfiguring your office layout so it is easier to make eye contact with patients while using a computer.

The bottom line

To enhance patient care and get the most out of electronic record systems, consider taking the following actions:

Learn how to optimally use your electronic records system and its functions, and evaluate how it may support or affect your clinical care.

Create procedures to optimize the functions and minimize risk.

Consider how your use of an EMR and the physical layout of technology will affect interactions with patients.

DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.