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What is drop-down decision-making in healthcare?

Healthcare as an industry is fully embracing decision-making aids to make health systems more efficient, while simultaneously optimizing reimbursement for the services provided. The question for those of us engaging the health system as patients is, do the decision-making aids produce better health outcomes?

Putting on my patient experience hat in answering this question makes me posit that the decision-making aids are producing more standardized outcomes for health systems yet as a patient, I do not want a standardized outcome, I want a personalized one. Success measured on this variable depends which direction you look along the patient-health system continuum of personalization versus standardization.

Most electronic health records (EHRs) are designed around drop-down menus to assure nothing is missed by physicians and their staff entering data during visits. As a result, EHRs move decision-making along an algorithmic journey based on what EHRs allow physicians to click, and often click most efficiently. Practicing physicians are under clinical production pressure and one dominant feature producing the pressure is the number of clicks needed during a day to do their job of entering EHR information.   A report from Kaiser Health News, outlined in an article by Schulte and Fry, cites that: 

many doctors say they spend half their day or more clicking pulldown menus and typing rather than interacting with patients.  An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout…  

It is difficult for our physicians to have meaningful discussions about values and goals of their patients when half the day is spent inputting data into EHRs.

One theme of improving EHR functionality in America is placed within the context of interoperability between EHR platforms. Which translated means our EHR healthcare data will flow more easily between clinical sites within a system and even between different health systems. Ideally, patients can be evaluated while on holiday in a distant state and their up-to-date record is accessible at the new site. This interoperability has a long way to go, since health systems increasingly view patient data as valuable and key for their analytics team. 

Again, drop-down menus are difficult to design to effectively capture personal values and goals of unique individuals. This is best accomplished with willing professionals with time to ask open ended questions and giving patients time to formulate answers from their heart.  

In conclusion, drop-down menus standardize care for health systems, and often move patients along the continuum toward themselves becoming standardized. That is not personal or patient-centric.