The document discusses the future of clinical documentation and the need to expand the current physician notes paradigm to support care coordination and the team care model. It notes that achieving care coordination is key to realizing the Triple Aim and that the current notes are not adequate. The notes need to include clinician colleagues, patients, and outcomes of the care plan. It also addresses principles of clinical documentation and the need to support care coordination through documentation during transitions of care.

1. The Future of Clinical
Documentation
and the Team Care Paradigm
Physician – Computer Connection
Panel Presentation
Ojai, CA
6/27/13
Claus Hamann MD, MS, FACP

2.  Getting coordination of care right is the key challenge to
achieving the Triple Aim.
 Our current notes paradigm isn’t ready for care
coordination prime-time.
 We need to expand our physician notes paradigm to
include
 Clinician colleagues
 Patients
 Outcomes of our Plan/Care
Take-Home Messages

3.  Goals: Clinical relevance, quality, efficiency
 Illegibility  Unreadability
 Is it only about the coding?
 Do we decouple notes from billing?
 Data format:
 Templates ↔ narrative
 Structured ↔ free-text
 Data entry: Keyboarding ↔ voice recognition
 Documentation at the speed of thought?
 Video recording?
 Documentation for the Care Continuum
Key Challenges
for Clinical Documentation

4.  Choose most appropriate and usable documentation
method based on clinical workflow and note content
requirements
 Avoid requiring one particular method,
e.g. structured documentation forcing categorical
data entry
 Support coordination of care, patient navigation
Principles of Clinical eDocumentation
Adapted from Rosenbloom ST, 2010

5.  eRx
 Use of EHRs
 Meaningful Use
o accurate procedure information
o transitions of care
 Physician employment
 Fee-for-Value
 Document for Value?
 Hospitalism and Continuity of Care
 Coordinating care through transitions
 Transitions of care processes  documentation challenges
Tipping Points
Effect on eDocumentation

6. Care Coordination Model
Institute for Healthcare Improvement
Adapted from Craig , 2011

7. Our patients’ needs:
 Chronic illnesses, disability
 Engagement
 Multi-specialty team care
 Interdisciplinary care planning, decisions
 PCMH, group visits
 Value-based, integrated care
 Care outcome – Quality
Clinical Notes, eDocumentation
and the Team Care Paradigm

8. …and our electronic capabilities prompt us to extend our
documentation paradigm.
 Preserve and include the patient’s voice, narrative
 Expand “Plan” to include provider colleagues, patients
 Add Quality to SOAP  SOAP-Q?
 Extend the Problem-Knowledge coupler to the Problem-
Knowledge-Action tripler
 Embrace post-acute, coordinated care and its
documentation, and…
…take aim at the documentation tipping point!
Our patients’ needs…

9.  Getting coordination of care right is the key challenge to
achieving the Triple Aim.
 Our current notes paradigm isn’t ready for care
coordination prime-time.
 We need to expand our physician notes paradigm to
include
 Clinician colleagues
 Patients
 Outcomes of our Plan/Care
Take-Home Messages