Happy to say our @AcadMedJournal article on #wikifying clinical documentation is now in print. Time to recapitulate the Twitter explainer from a few months ago! 1/n @jefferyrlsmith
As an enthusiastic @Wikipedia user, producer of clinical docs at @VUMChealth, and deputy editor of the medical wiki HemOnc.org, I teamed up with @jefferylsmith (VP of Public Policy at @AMIAinformatics) & Adam Wright @BrighamWomens to put out this thought piece 2/11
We came together around the groundswell of concern about the negative effects of #EHRs on the quality of clinical documents. Having delved deep into the history of clinical documentation, we began to realize how far afield from original intent we are. 3/11
For ~4,000 years, the main purpose of clinical records was didactics - teaching the next generation of doctors. It is only in the past 50 years that the shift to a legal and billing document has created what we live with now in EHRs. A good overview: bit.ly/2FW1E2Y 4/11
Meanwhile, knowledge has been liberated through collaborative efforts elsewhere, most notably @Wikipedia. Some medical schools now teach students how to edit wikis, led by @UCSF’s @AminMDMA. So how about a wiki for clinical documentation? 5/11
We argue for #wikifying the #EHR for these reasons: 1) wikis are collaborative; 2) wikis allows for adjudication and moderation - the #PCP role does not go away and could in fact be even more important as a central arbiter of the record.
3) wikis can be access controlled, addressing the inevitable security issues; 4) wikis are modular and relational which is a real departure from today’s #EHR. A wiki can explicitly link medical problems to their treatments, and problems to the other problems they cause. 6/11
No #EHR does this now. As a researcher who devotes much of my time to information extraction with #NLP, I’m keenly aware of the difficulty of linking treatments to their adverse events (at scale). 7/11
5) Wikis are inherently longitudinal; 6) wikis are web-accessible (this remains everyone’s favorite “feature” of the #EHR @workinmypajamas); 7) wikis can use #semantic web technology to formalize relationships such as problem -> treatment. 8/11
And lastly 8) wikis can be API-enabled. This allows for the embedding of apps, tools, calculators, and widgets right inside the clinical document, using standards such as SMART on #FHIR. @HL7 @SMARTHealthIT @Bos_CHIP 9/n
Altogether, we hope this isn't just another straw man! We propose that a pilot could be conducted, perhaps by @CMSGov and we’d eagerly advise any such effort. Please see our mockup here: bit.ly/2COV0aX (thx @Hem_Onc for hosting, and #DeepPhe for the synthetic notes) 10/n
Finally, we wrote this from the clinician’s #POV but could patients help lead the way? The @myopennotes movement could work really well with wikis, which could perhaps even aide in a transition from clinician-owned to patient-owned documentation! 11/11 (fin) @TheLizArmy
And a direct link would be helpful! Here it is: journals.lww.com/academicmedici…
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