From Text to Treatment: How Medical Discharge Letters Are Used as a Key Artifact for Managing Patient Care

People involved

Anastasiya Zakreuskaya
Ignacio Avellino
Wendy Mackay

Abstract

Hospital physicians must navigate through vast quantities of patient information represented in text-based reports. Although intended to improve patient care, their effectiveness hinges on each physician’s ability to successfully handle and interpret fragmented information from diverse sources. The increasing automation of text interactions are a potential support but are still at the early phase of implementation in real-world scenarios. We observed 144 hours of clinical shifts in a German internal medicine hospital and collected structured field notes on physicians’ current practices with text-based reports to enrich existing understanding of the requirements for including automation to clinical text. We identified medical discharge letters as most frequently consulted text document and a qualitative analysis of the field notes revealed that this document acts as a key artifact that serves different roles and purposes in the hospitalization of a patient. Based on our findings we discuss possible loss of these nuanced uses through automation and propose design implications for medical text reports.

Project description

Text-based reports offer a well-established medium for exchanging information in collaborative settings. In hospitals, the core medical record consists of conventional text blocks with clinical notes to summarize a patient’s history and further procedures [1].

With growing amounts of available data, physicians need to know how to navigate through given documents or systems and select specific subsets of information from a large fragmented quantity of patient data [2]. Over the years, this interpretation and documentation of data has become an integral part of a physician’s work and often exceeds the time spent on direct patient care [3].

In this work, we examined physician’s current interaction with text-based documents to enrich existing understanding of requirements for new text automation systems. We are particularly interested in addressing the following research questions:

  1. Which clinical documents do physicians consult during their workflow,
  2. for which purpose,
  3. and which challenges do they encounter?

[1]Jørgen P Bansler, Erling C Havn, Kjeld Schmidt, Troels Mønsted, Helen Høgh Petersen, and Jesper Hastrup Svendsen. 2016. Cooperative epistemic work in medical practice: an analysis of physicians’ clinical notes. Computer Supported Cooperative Work (CSCW) 25 (2016), 503–546.

[2] Troels Mønsted, Madhu C Reddy, and Jørgen P Bansler. 2011. The use of narratives in medical work: A field study of physician-patient consultations. In ECSCW 2011: Proceedings of the 12th European Conference on Computer Supported Cooperative Work, 24-28 September 2011, Aarhus Denmark. Springer, 81–100.

[3] Elske Ammenwerth and H-P Spötl. 2009. The time needed for clinical documentation versus direct patient care. Methods of information in medicine 48, 01 (2009), 84–91.