In my last post, I arrived at the conclusion that the main element in the electronic healthcare record should be a list of problems and each of those problems should be an SRR, that is a document that is updated with the most recent data pertaining to this problem, not a document that gets replaced and shoved out in a queue as in a TAS. (Back up a few posts to find the definition of these terms.)
Ok, fine, if you accept that, we now have a problem of defining the contents of this SRR, this problem document. It could very well start out as an empty document or a document with a few predefined sections such as “Tests”, “Clinical signs”, “Medications”. Under each of those sections, the doctor could then add in the tests and signs he plans on doing or checking and then later check them off or fill in results. That’s certainly one viable method.
But we’ll soon notice that most problems people show up with are pretty common and have established guidelines we can reuse. For diabetes, for instance, we very well know which tests we want to perform, which values constitute diagnostic values for the disease and which follow-up referrals and exams that need to be done. Even criteria for reporting the problem to different tracking databases are pretty clearcut. So it would only be natural to keep these guidelines in a common database so all doctors using the same system will follow up the same disease the same way. Additionally, if the guideline changes at some point in time, the diagnostic and treatment plans of patients already in the system will signal the change to the physician the next time the patient is seen.
But won’t it be prohibitively expensive to set up all these guidelines? Um, no, it’s already been done. All these guidelines exist at least on paper and in most places in the world as PDF documents. But in some places, such as Sweden, we even have them in an almost immediately useful form. Just check out the site viss.nu and there you have them. These guidelines can be used almost without change in an electronic healthcare record system, if checkboxes and input fields are added and a copy of the guideline is linked to the individual EHR patient file.
In conclusion, we actually do have the SRR we need for the medical records. It’s either an empty document the physician can add his planning to, or it is a predetermined guideline adapted for this system, but taken from one of the many excellent repositories of clinical guidelines that already exist. Which then also finally get to be used in real practice.