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Why There Won’t Be a Thomas Edison in Physician Documentation Reform

April 26, 2014
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Reforming physician documentation to eliminate “note bloat” and improve patient safety will require a very broad group effort

I ran across an interesting article from The Atlantic recently, while doing some research online. The article’s headline grabbed me immediately. Here it is: “Forget Edison: This is How History’s Greatest Inventions Really Happened”—and the deck read, “The myth of the solitary inventor—in 8 short stories.” Who wouldn’t want to read an article like that?

As Derek Thompson writes, “The world’s most famous inventors are household names. As we all know, Thomas Edison invented the light bulb, Alexander Graham Bell invented the phone, and Eli Whitney invented the cotton gin. Except they didn’t.” Well—just speaking as a writer, that lede certainly got my attention! Thompson then goes on to say, “The ideas didn’t spring, Athena-like, fully formed from their brains. In fact, they didn’t spring fully formed from anybody’s brains. That is the myth of the lonely inventor and the eureka moment.”

Thompson goes on to quote a 2011 scholarly paper, “The Myth of the Sole Inventor,” by Mark A. Lemley, which inspired his writing his article. And he goes on to write about the cotton gin, the telegraph, the telephone, the movie projector, the automobile, the airplane, and the television, and points out how complicated the invention stories of all of those inventions really were, and that, “As we’ve learned, every great inventor stands on the shoulders of giants.”

As Thompson notes, “When the Wright brothers asked the Smithsonian for all available information on the history of flight in 1899, they opened a history that had begun with Da Vinci’s scribbling, and continued all the way to the 19th-century gliders of Otto Lilienthal.” The bottom line on all this is that invention really is a collaborative thing, a group effort, over time, as are so many other processes in the world. And that certainly goes for the current situation around physician documentation within the electronic health record (EHR) as well. With physician documentation now being required to support so many different purposes—documentation of outcomes for quality-based purchasing under healthcare reform, documentation of quality metrics and other measures for the meaningful use process, documentation of specific clinical elements to support billing under the new ICD-10 coding system mandated for implementation this autumn—as well as the traditional, historical purposes of recording an individual physician’s information as a mnemonic record, and for appropriately sharing that information with fellow clinicians attending to the same patient’s care—physician documentation sometimes feels like the proverbial camel with too many things on its back.

As CMIOs, CIOs, and industry experts told me in my reporting for this month’s cover story, reforming physician documentation is going to take a lot of inventiveness, not to mention a lot of discipline and energy. In this area, there simply won’t be a single “inventor” who solves any particular problem or issue; instead, teams of leaders at pioneering patient care organizations are moving forward as quickly as they can to make physician documentation work for physicians in office and inpatient practice, while fulfilling a welter of policy and regulatory mandates.

So in physician documentation reform, as in every other meaningful process in healthcare, we will see groups of “mini-Edisons” having lots of different “eureka” moments in the coming months and years, until eventually, the broad documentation process will be reformed to work better for everyone. So invention—and inventiveness—in healthcare will, ultimately, replicate the pattern in other areas of endeavor. And ultimately, the collaboration involved will prove to be better for everyone involved in the process, in any case.