Thoughtflow, Part 2: think and THEN work.

On January 18, we began a discussion on thoughtflow. "Doctors think very differently during a patient encounter than when they are discussing patient care, say with colleagues..." The way we think throughout the course of an exam affects the way we work. This week, I came across what's perhaps an even more obvious example: that doctors also think very differently from each other during a patient encounter. 


Let's jump into the exam lane where you're doing a typical front-to-back examination of the eye. You look at and record findings vis-a-vis the lids, the lens, the optic nerve and the macula (among others, of course). But here's the question: did you go down through the list looking entirely at the right eye then move over to the left eye? Or did you look at the lids OD/OS, followed by the lens OD/OS, then the optic nerve OD/OS, and so on? These are different ways of thinking, are they not? My simple example only scratches the surface of a whole host of ways in which providers think differently.


That's no surprise, no big deal. So what, you may ask? Well, no big deal if you're using a paper chart and the exam sheet let's you jump around any way you like. EHRs, on the other hand, have things like tab order and buttons that transfer OD ->OS. Did you want one button or 35 throughout the exam? In EHRs, we count clicks and analyze closely how much the software speeds us up or slows us down. One of the hurdles we had to overcome in designing our EHRs was that they were highly efficient for doctors (perhaps the majority?) who take the "vertical" approach but very inefficient for those who took a "horizontal" approach.


The point really is that EHRs must accommodate these different ways of thinking and then working. Traditional EMRs recorded results; next-generation EHRs must do that even better, more quickly, to a higher standard but then move beyond findings to thinking, supporting your clinical decisions, letting you see more patients in less time. That's thoughtflow. That's not just surviving but thriving in the health care reform world.


Alistair Jackson, M.Ed.