Medical Professional Publications

Communication Remains a Problem

Regulatory Corner

(From the June 2017 Issue of MedStat)

Rick McClead MD MHAWritten by Rick McClead MD MHA, Associate CMO, Nationwide Children’s Hospital

The electronic medical record (EMR) has many useful features that help make our patients safer. For example, we can read the notes written by another practitioner. The EMR decision support tools prevent many medication errors. We are alerted to best practices as we care for our patients. However, the EMR has a dark side for which everyone must be on the alert. The EMR is not always the best way to communicate key information. Critical information about patients can be buried in various EMR notes, beneath an excess of lab data, billing and regulatory documentation, and historical data documented elsewhere. This note bloat is impairing our ability to communicate with one another. Is there a better way?

One solution may be to hide all the extraneous information inside hyperlinks. For example, a hyperlink in a progress note could expand to show non-critical lab data, current meds, past medical history, and such.

Another solution might be to turn the classic problem-oriented SOAP note (subjective, objective, assessment, and plan) upside down and make it an APSO note (assessment, plan, subjective, objective). This note structure would place the practitioner’s thinking front and center. The subjective and objective information on which the assessment and plan are based would follow. But, are there hidden dangers associated with APSO notes? For instance, will patient care teams have tunnel vision and not read past the assessment and plan?

In the future, the quality and safety executive leaders plan to focus on improving communication within and outside the organization. We could use everyone’s help in finding the best ways to communicate. Please call or send me an email with your thoughts. Have you had experience with either of the “solutions” mentioned above? What are the good, the bad, and the ugly about communication?

Contact Dr. McClead by calling (614) 722-5121 or email

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Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000