A Piece of Paper as a Personal Health Record

GodinI live in a world looking for digital solutions to some of health’s biggest problems.  I love watching this all play out.

So yesterday Seth Godin tells the world that a piece of paper could save your life.  He’s advocating that everyone write down their history and carry it around with them.  Yes, your personal health record on a piece of 8 1/2 by 11 inch paper.  As much as it kills me to admit it, there’s a certain amount of wisdom to this.  And not novel, really.  Patients of mine have been doing this for years.

I see loads of chronically ill children.  What’s remarkable is that there’s no way for me to easily get key elements of their child’s history into the EMR.  Despite the tens of millions  of dollars spent on EPIC, it can’t be done in a way that’s practical.  Sure we could scan their paper summary as a media file, but if you know anything about EPIC, it is probably easier if the patient just kept the paper in their wallet.  What’s more discouraging is that if the child came from another institution with a fancy, competing EMR, it still couldn’t be done very easily.

And I don’t need pie charts, reams of data, exhaustive diaries, books, ‘complete medical records’ or thumb drives.  Just the facts to start with (QS data may be important later).  I might even suggest that patients try to limit their summary to one page, focusing on the major issues.  Physical constraints force to think about what’s important.

What would be really cool would be a nicely done, thoughtful sketchnote graphically detailing key elements of a patient’s history.

It’s remarkable that despite how far we’ve come it still comes down to a piece of paper.  We have such a long way to go.

Clinical Sketchnotes

imgresI just read The Sketchnote Handbook – The Illustrated Guide to Visual Note Taking, a new book released by Mike Rohde.  It details a method of note taking that I’ve been witnessing at major meetings over the last couple of years.  For the uninformed, sketchnotes are rich visual notes created from a mix of handwriting, drawings, hand-drawn typography, shapes and visual elements like arrows, boxes and lines.

The reason this caught my attention is that I use sketchnotes in my clinic.  I just didn’t know they were called sketchnotes.  Mine are on a white board, however, and they typically involve my teaching with parents.  The use of bulleted lists, titles, and schematic, cartoon-like anatomic images has changed the way my parents understand their kids and their problems.  It’s changed the way I communicate (my 2009 description of my white board activity).

What I’ve observed over the past three years is that this type of visual presentation of physiology, differential diagnosis, and plan represents an extremely effective means of capturing and sharing my our thinking in the exam room.  While EPIC is supposed to represent everything about a patient’s history and plan, I’ve found myself on several occasions hovering around a parents smartphone to review an image of my colorful 4×5 foot board taken from the original consult.  Parents love to take pictures of my clinical sketchnotes with their smartphones.

Here’s why visual thinking (like sketchnotes) works in a pediatric exam room:

  • Overwhelmed parents appreciate a simple boil-down of their child’s problem.
  • Parents can correct or modify facts appearing front of them.
  • Kids love seeing their doctor draw pictures.
  • The process demonstrates your engaged, active involvement in a child’s care.

This could be called clinical sketchnoting.  While this live, visual representation of concepts, ideas and data isn’t new, few health providers have applied it in the health care setting.

sketchnotePart of me wonders if this should be taken to another level.  Reading this book got me thinking: what about the use of sketchnotes to tell a patient’s story?  I can imagine a child’s story of abdominal pain captured in the way that almost instantly conveys the critical elements of the clinical history.  Instead of reviewing sentences and paragraphs of dry narrative during a follow-up visit, the snapshot of elements captured on a sketchnote would tell the patient’s story in a fraction of the time.  Typographic emphasis would draw us to the most important elements in the story or plan.  Perhaps a clinical sketchnote done in an exam room could be scanned in to EPIC as media.

Every clinician serious about communication should read Sketchnotes to see how elements of this technique can be applied in their setting.  We should experiment and grow with the way we deliver information our patients.

While you may think that you need to draw to create sketchnotes, Rohde drives home the point that it’s about hearing and capturing meaningful ideas, not the creation of art.  And my experience has been that once you learn how to draw simple intestinal villi (that become magically damaged with your eraser) you find yourself doing it again and again, each time with more efficiency and energy.

Sketchnotes is a quick, fun read.  The book is beautiful to hold and feel.  It is printed on heavy paper and has an indescribable velveteen feel to it.  Highly recommended.

Tell me what you think.  Have you had a doctor sketchnote your personal story?  Why not?

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