Fun with Problems

I worked with a large group who had been using TouchWorks for a year or so, after converting data from their previous EHR (a predecessor of TouchWorks). The conversion brought their Problems into TouchWorks; however, the problems were viewed differently and were now also viewed and managed by physicians, rather than only the nursing staff. While these changes were generally fine, the personal and family history that they had captured on paper, then showed in their old EHR, now cluttered patients’ problem lists – they had 10 copies of “Coffee Consumption” or “Denies Drug Use”. They also commonly had patients with duplicates of other problems as these didn’t appear as duplicates in the previous EHR.

We spent a few weeks designing a neat de-duplication process. I’ll spare you the details, but it went along the lines of finding problems of the same type, status, category and view. We’d take the oldest entry and keep it. We’d mark the rest as Entered in Error; however, we didn’t toss them away completely – we’d store each problem entry as an assessment on the first problem entry so you could always view the problem details to see the Audit/History.

We also took out some other attributes of the converted problems, such as the category of History Of for every problem and comments that the physician group thought might be useful.

Before I continue, I have to say – both the physician group and those assisting with the conversion (at Allscripts) did a great job of converting the 12 years of electronic charts (about 2MM patients). I think the biggest issue was the group not having a year’s experience using TouchWorks to make some of the decisions – hindsight is 20/20.

Luckily, we had the ability to make corrections as we went. We were able to convert millions of problems, removing duplicates (while maintaining their history!) and saving the clinicians a great amount of time and frustration. An internal medicine doc remarked that it saved him somewhere in the area of 100 hours of effort (not to mention the gray hairs).

I wouldn’t say we did anything extraordinary, but just had the luck to work on a fun project that helped out a couple hundred nurses and physicians. And hopefully make their transition to a (full) EHR a little more pleasant.

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