One of the noticeable changes with NOSH 2.0’s encounter layout is the presence of the SOAP note. For those not in the medical field, SOAP stands for Subjective, Objective, Assessment, and Plan. It’s a very simple, clear way of noting an encounter, both in the inpatient and outpatient setting that I, as a medical student and resident many years ago and using paper charts, had learned to utilize to communicate to myself and others on the care team.
Since the advent of EHR’s, documentation has veered farther and farther away from this simple SOAP note. And to this day, I still don’t know exactly why. The obvious reason to me is that we’re moving towards structured data, starting with patient demographics and vital signs, but now it’s in the actual note-taking too, thanks to Meaningful Use.
But that is where the line is crossed, probably with most physicians, where usability of the EHR becomes unusable and frustrating. Physicians don’t think or notate intuitively in structured data. Humans are not bits of structured data, especially in the subjective section. Physicians describe the patient and the encounter as if it is short story. The patient is a story. How do you describe skin lesions, and psychological manifestations such as speech, affect, presentation in a structured way? That is why medicine can’t be like a restaurant where there is a set menu with finite descriptors or items. However vast the SNOMED CT definitions can be; it still does not give us the full picture; especially those in primary care dealing with patients who have chronic illnesses.
Since NOSH was never Meaningful Use certified to begin with (and proud not to be), I felt I could make things simple for the physician user. The first iteration of NOSH was better, in my opinion, than current EHR’s, but it still was too regimented for my liking. As it became clear to me how the new template engine was going to work, I finally felt that NOSH 2.0 will allow me to really simplify the encounter down back to the good ol’ SOAP elements. Now that brings back good memories. And happy physicians too!
Even on a mobile device, NOSH 2.0’s simplicity really makes it easy for documentation to happen; and if you really want some structure data that is useful and customizable to your needs, the tagging feature of NOSH is clearly the best way to go than structured data fields scattered throughout the encounter. You can query tags that are created and saved for each item in NOSH. There will be a time when NOSH will be able to auto-generate tags based on natural language processing of the note so you don’t have to think of the tag you want to use too!