Scribus in the Hospital

This is something I'm experimenting with lately. The idea was to be able to make my notes for the chart by typing them in. This raises a number of questions, like how much time does that take? Does this really work? Can you do it on some kind of regular/daily basis?

I'm certainly not trying to be an advocate of the concept or of how I do it. For many years in the office, I generally take few if any handwritten notes. I sit there with the patient, take their history, and type out my notes, then save them in the chart. I used to print them out and physically put them in the chart, but since we've had an EMR, they just get saved on the server. It's doable if, like me, you're a touch typist, and certainly leads to something anyone can read.

When I started it I wondered about how I would manage with the fact that word processor text entry is a linear process -- you keep appending what you've done, whereas if you're handwriting a note, you can skip around the page and go back and stick something up where it seems to fit better. But that wasn't such a big deal once I figured out a standard outline of sorts to use, and it isn't so hard to use arrow keys or whatever to skip up and down a bit. You can always reorganize later, if you want, but these are just working notes anyway.

The next step was doing all my own typing in the office. All of it. The official notes that go to referring docs, letters for this or that. It started out when we were having a bit of a backlog in typing, and it might take a couple of weeks for my transcriptions to come back. Meanwhile the patient calls, and I'm trying to remember what I said in my dictation, which I don't know until my typing gets done. Now that I do it myself, I finish all of it the day I see the patient, so it's in the mail and in the chart that same day. Let me add that my "style" if you will is a narrative style. I am not fond (putting it mildly) of these highly structured tabular/spreadsheet-like reports that are all too common from doctors' offices these days, where most things are in words and a few short phrases, and lots of medical lingo.

So when you do all this typing, you become pretty proficient at it. It may have been out of boredom, but I decided to experiment with hospital chart notes. While we have a LOT of the patients' information computerized, we still cling to paper charts, especially for the doctors handwritten notes. I dictate my consultations just like everyone else, but I've always written a fairly long note before dictating -- it helps me collect my thoughts for dictating as well as have something in the chart before the transcription gets done (actually usually within an hour or two of dictating most days).

For the heck of it I decided to create a progress note sheet, and did so with Scribus, so everything you see in that picture at the beginning of this post was created in Scribus, even the bar code, which by the way just denotes the type of page it is -- I gather that when these pages get scanned into the system the scanner uses the bar code to make sure each page gets to the right section in the chart.

In my next post, I'll take the next step, turning this generic page into the most legible doctor's note you'll ever see.