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It’s Time to Wikify Clinical Documentation

How Collaborative Authorship Can Reduce the Burden and Improve the Quality of the Electronic Health Record

Warner, Jeremy L., MD, MS; Smith, Jeffery, MPP; Wright, Adam, PhD

doi: 10.1097/ACM.0000000000002613
Perspectives
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Electronic health records (EHRs) have become ubiquitous tools and represent the standard of care for 96% of hospitals and 86% of ambulatory physicians in the United States. With adoption of EHRs came the promise of improved efficiency, higher-quality care, and lower costs. Unfortunately, some clinicians are now spending twice as much time on documentation as they spend seeing patients, and the documentation paradigm of problem-oriented medical records is contributing to this imbalance. It is time to consider new innovations. The collaborative wiki format offers many opportunities to ease the burden of documentation as well as to increase the usefulness of the recorded clinical data. Wikis support multiple authorship, have built-in features to track edits and changes, allow for contextual linkages (e.g., linking medical problems to their treatment), and support new technologies such as application programming interfaces, which allow for safe and secure exchange of information. In this Perspective, the authors describe the rationale for considering this approach to clinical documentation and propose a pilot to learn about its effectiveness. They believe wiki-based documentation will become increasingly attractive, especially as new legislation and directives from policymakers seek to reduce the crushing documentation burden and as the U.S. health care system transitions from an episode-based payment structure to a value-based, outcomes-focused system.

J.L. Warner is associate professor, Departments of Medicine and Biomedical Informatics, Vanderbilt University, Nashville, Tennessee; ORCID: https://orcid.org/0000-0002-2851-7242.

J. Smith is vice president of public policy, American Medical Informatics Association, Bethesda, Maryland.

A. Wright is associate professor, Department of General Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-6844-145X.

Funding/Support: None reported.

Other disclosures: J.L. Warner is cofounder of HemOnc.org LLC and deputy editor of HemOnc.org, a free, collaborative wiki of chemotherapy regimen information; this position is uncompensated. J. Smith and A. Wright have no conflicts of interest to disclose.

Ethical approval: Reported as not applicable.

Disclaimer: The views expressed are those of the authors and do not necessarily reflect the views of their institutions or employers.

Supplemental digital content for this article is available at https://hemonc.org/wiki/Academic_Medicine_exhibit.

Correspondence should be addressed to Jeremy L. Warner, 2220 Pierce Ave. PRB 777, Nashville, TN 37232; telephone: (615) 322-5000; e-mail: Jeremy.warner@vumc.org.

© 2019 by the Association of American Medical Colleges