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