Restoring the Story and Creating a Valuable Clinical Note
Authors: Heather E. Gantzer, Brian L. Block, Lacy C. Hobgood, Janice Tufte
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions1 September 2020Restoring the Story and Creating a Valuable Clinical NoteHeather E. Gantzer, MD, Brian L. Block, MD, Lacy C. Hobgood, MD, and Janice TufteHeather E. Gantzer, MDPark Nicollet Clinic, Methodist Hospital, St. Louis Park, Minnesota (H.E.G.), Brian L. Block, MDUniversity of California, San Francisco, San Francisco, California (B.L.B.), Lacy C. Hobgood, MDBrody School of Medicine, East Carolina University, Greenville, North Carolina (L.C.H.), and Janice TufteHassanah Consulting, Seattle, Washington (J.T.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0934 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Today's clinical notes don't serve anyone particularly well. Cogent summaries are few and far between, having been replaced by templates that emphasize billability over interpretability. These long, overly detailed documents—with dozens of imported values ranging from test results to problem lists—manage to simultaneously over- and underwhelm. On the one hand, generating and reading such a note are time-consuming tasks that require substantial cognitive load and contribute to burnout (1, 2). Yet, the final product still fails to communicate much useful information (3), and much of what it does include may not even be accurate (4).There is a critical distinction ...References1. Erickson SM, Rockwern B, Koltov M, et al; Medical Practice and Quality Committee of the American College of Physicians. Putting patients first by reducing administrative tasks in health care. A position paper of the American College of Physicians. Ann Intern Med. 2017;166:659-661. [PMID: 28346948]. doi:10.7326/M16-2697 LinkGoogle Scholar2. Morgan M. Matt Morgan: when bullet points miss the heart. BMJ. 2019;366:l5500. [PMID: 31530546] doi:10.1136/bmj.l5500 CrossrefMedlineGoogle Scholar3. Overhage JM, McCallie D. Physician time spent using the electronic health record during outpatient encounters. A descriptive study. Ann Intern Med. 2020;172:169-174. [PMID: 31931523]. doi:10.7326/M18-3684 LinkGoogle Scholar4. Berdahl CT, Moran GJ, McBride O, et al. Concordance between electronic clinical documentation and physicians' observed behavior. JAMA Netw Open. 2019;2:e1911390. [PMID: 31532513] doi:10.1001/jamanetworkopen.2019.11390 CrossrefMedlineGoogle Scholar5. Hendrickson MA, Melton GB, Pitt MB. The review of systems, the electronic health record, and billing. JAMA. 2019;322:115-116. [PMID: 31173055] doi:10.1001/jama.2019.5667 CrossrefMedlineGoogle Scholar6. Centers for Medicare & Medicaid Services. 2019 Medicare Physician Fee Schedule. 22 November 2018. Accessed at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1693-F.html on 1 May 2020. Google Scholar Author, Article, and Disclosure InformationAffiliations: Park Nicollet Clinic, Methodist Hospital, St. Louis Park, Minnesota (H.E.G.)University of California, San Francisco, San Francisco, California (B.L.B.)Brody School of Medicine, East Carolina University, Greenville, North Carolina (L.C.H.)Hassanah Consulting, Seattle, Washington (J.T.)Note: Dr. Gantzer currently serves as the Chair of the Board of Regents of the American College of Physicians.Acknowledgment: The authors thank the members of the American College of Physicians Restoring the Story Task Force for their contributions and thoughtful perspectives in discussion of this topic.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0934.Corresponding Author: Heather E. Gantzer, MD, Park Nicollet Clinic, 3800 Park Nicollet Boulevard, St. Louis Park, MN 55416; e-mail, [email protected]com.Correction: This article was corrected on 15 September 2020 to revise one of the abbreviations defined in the figure legend.Current Author Addresses: Dr. Gantzer: Park Nicollet Clinic, 3800 Park Nicollet Boulevard, St. Louis Park, MN 55416.Dr. Block: Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, 513 Parnassus Avenue, Room 1314, San Francisco, CA 94143.Dr. Hobgood: Division of Internal Medicine–Pediatrics, Brody School of Medicine, East Carolina University, 517 Moye Boulevard, 2nd Floor, Greenville, NC 27834.Ms. Tufte: 412 Eleventh Avenue, No. 106, Seattle, WA 98122.Author Contributions: Conception and design: H.E. Gantzer, B.L. Block, L.C. Hobgood.Drafting of the article: H.E. Gantzer, B.L. Block, J. Tufte.Critical revision of the article for important intellectual content: H.E. Gantzer, B.L. Block, L.C. Hobgood, J. Tufte.Final approval of the article: H.E. Gantzer, B.L. Block, L.C. Hobgood, J. Tufte.Administrative, technical, or logistic support: H.E. Gantzer.Collection and assembly of data: L.C. Hobgood.This article was published at Annals.org on 14 July 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChekhov on Epic Samuel C. Durso Annals On Call - Restoring the Story to Health Records Robert M. Centor and Heather E. Gantzer Metrics Cited byI had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notesA Patient-Centered Approach to Writing Ambulatory Visit Notes in the Cures Act EraRestoring Meaningful Content to the Medical Record: Standardizing Measurement Could Improve EHR Utility While Decreasing BurdenData standards for transcatheter aortic valve implantation: the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart)"Note Bloat" impacts deep learning-based NLP models for clinical prediction tasksWriting Is Thinking: Implementation and Evaluation of an Internal Medicine Residency Clinical Reasoning and Documentation CurriculumLinking the Humanities With Clinical Reasoning: Proposing an Integrative Conceptual Model for a Graduate Medical Education Humanities CurriculumDiagnostic error experiences of patients and families with limited English-language health literacy or disadvantaged socioeconomic position in a cross-sectional US population-based surveyLength and Redundancy of Outpatient Progress Notes Across a Decade at an Academic Medical CenterNew U.S. Law Mandates Access to Clinical Notes: Implications for Patients and CliniciansCharlotte Blease, PhD, Jan Walker, RN, MBA, Catherine M. DesRoches, DrPh, and Tom Delbanco, MDWhen Patients Read Their Story in Clinical NotesHeather E. Gantzer, MDWriting Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study 1 September 2020Volume 173, Issue 5Page: 380-382KeywordsAllergic diseasesAllergy and immunologyDisclosureEchocardiographyElectronic medical recordsHeart diseasesHeart failureMedicarePulmonary diseasesRenal failure ePublished: 14 July 2020 Issue Published: 1 September 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...