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Documenting in the EHR in ALL CAPS

Documenting in the EHR in ALL CAPS

On the first day of my allscripts instruction, I was advised that when documenting in the EHR, I should always use all caps, in other words, to always type in capital letters. As someone who is trained in graphic design, this irked me! Capital letters should be used for a reason, not as a default. It also bothered me knowing that typing in all caps on the internet is an analog for shouting.

Why, I asked?

Trust me – the instructor said. Just do it. Otherwise no one will be able to read your reports.

I resolved not to type in allcaps. However, few weeks into the job, I gave up. Why? Because the reports generated in allscripts are clumsy and unreadable. So many check marked boxes generating more and more words that are not at all significant to the clinician!

A little background: As the case manager, I usually need to generate an allscripts report based on the patient’s last assessment. It’s kind of a replacement for getting a verbal report from the last nurse. This is done when picking up new patients, or getting new admissions. But 80% of the data that the assessment generates is irrelevant to me at that moment. The thing that is relevant is a summary from the nurse describing what happened at the visit, or why the patient is being admitted. So in the visit summary box, the nurse types a few paragraphs in capital letters. Then, when the next nurse is scanning the oodles of useless info generated by the assessment, her eyes go straight to the good stuff – the visit summary in all caps.

Sadly, this is not constrained to just assessments. The nurses who cover patients on nights and weekends are required to email a report to the case managers. So they simply copy the visit summaries (cause that’s the good stuff, right?) and paste it into the email. As a consequence of this, most of the nurses have acquired the habit of ALWAYS TYPING IN ALLCAPS (which is still annoying, but less so now that I see why this habit has evolved.)

In a small way it’s kind of cool, though. It’s a clinician hack. Give a nurse a crappy EHR and they will find a way to improve it to fit their needs.

How difficult would it be for an EHR to generate well-designed easily readable reports? Not too difficult I would guess, but the technical expertise to accomplish this costs money. Unfortunately this goes back to a big problem for nurses in healthcare technology – we do not get to see the benefits of tech, unless it affects the bottom line. So unless you can find a way to connect beautifully generated reports with saving money, it isn’t going to happen.

There is hope though. As more and more patients are demanding a copy of their health record, the demand for adequately designed documents will increase. So nurses will either wait for this effect to trickle down to them, or come up with some better hacks.

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