Narrative medicine and the EHR

[John “Jollis” Willis]

Hello all,

For once, I'm here to start a discussion and not a fire.

Is anyone in the community familiar with Dr. Rita Charon and her work on narrative medicine? It makes a lot of sense to me that the human stories behind medical interactions are of utmost importance.

Yet, to my knowledge, our EHRs don't really reflect narrative. 

My take on software tends to come fairly strongly from a liberal arts perspective, so I like to see technology as human augmentation, and like the idea of software as a bridge. Something of a narrative interface.

I wonder how the idea of a narrative interface--something that brings humanity into technology--fits into the EHR? 

The human story really begins when that first ADT message comes in, and should continue through every encounter, every TIU note, every lab order, every reminder. Human story touches every interaction. Do we reflect this? Could it shift outcomes?

Perhaps an LLM can derive context from a note and provide gentle prompting to fill out the story. Some human application of generative AI.

I think VistA is already the most human EHR in existence. How can that be converted into a truly narrative interface?

Just some thoughts from a rainy morning.

[David Whitten]

I think the notes part of CPRS is related to part of what you are talking about. 

Narrative structure is far beyond what is currently being done. 

Notes also allow for structured questions to organize them as well, pulling in part of the EHR record, 

as well with the Clinical Reminder templates the ability to push data into the EHR record. 

At Central Regional Hospital Dr. Matt King also had me develop some tools to maintain history and

 pull parts of previous notes into the current note to provide narrative updates on plans and progress of care. 

Joseph Puthooran also made a much more comprehensive Care Plan and method for Interdisciplinary Teams 

which interacted with VistA to make a unique and powerful addition to the plan. Marci Keiser and Joseph Thurber 

were involved with a lot of the details as well as Dr. King. 

I am reading some of Dr. Rita Charon’s work now.

Thanks for the reference. 

Dave Whitten

713-870-3834

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[K.S. Bhaskar]

I remember from the VistA implementation by the Mexican Social Security Administration that they rewrote the CPRS GUI because apparently in Mexico, the physician's notes are considered critical and have a formal structure to them. But I don't know the details.

Regards

- Bhaskar

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[Alvin Marcelo]

Dear Hardhats,

Is anyone working on:

1) MUMPS-on-FHIR?

or

2) wrapping a modern GUI (Angular,React, Vue) around a MUMPS instance and using robotic process automation (or any similar intelligent parsing mechanisms)?

Alvin

Alvin B. Marcelo, MD https://orcid.org/0000-0001-6250-9169, https://bit.ly/alvinmarcelo

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[Paul Simon]

Hi,

I've been working on a lightweight document database that natively handles JSON documents, including healthcare standards like FHIR. It's open source, and you can check it out here:
https://github.com/psimon2/doc-mdb

Thanks
-- Paul.

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[OldMster]

I use Vue to modernize our Mumps lab system, works very well using Rob Tweed/Chris Munts mgweb product to connect to the Mumps back end