Should You Set Defaults in Your Medical Reports?

In healthcare improving efficiency without negatively impacting patient outcomes is paramount. Finding more efficient workflows is critical not just to improving the patient experience but also to reducing costs and waste. Synoptic reporting has been consistently shown to be a faster, cheaper, and more accurate method of reporting than narrative transcription [1]. By providing consistently formatted reports less prone to error and eliminating the necessity of transcription altogether, it is also a more efficient means of reporting [2].

However, the efficiency gains of synoptic reporting don’t end with eliminating transcription costs and faster completion of more accurate reports. Electronic versions of synoptic reporting have the potential to be even more efficient through the use of default answers and removing the necessity for answering basic questions common to all your patients. However, it’s important to strike the right balance between efficient entry and ensuring that accuracy isn’t compromised.

Using Defaults in Healthcare Software.

Using defaults in your healthcare reporting software can help speed up report completion, but the practice isn’t without its pitfalls. It’s important that you feel comfortable with your software. If you’re experienced using it, you’ll better understand when defaults will be helpful without compromising patient care, and what default is best suited to that particular question.

Types of Defaults.

Synoptic reporting EMR software profile defaults for pathology
An example of Synoptec’s profiling defaults for pathology.

Before getting into the best practices for using defaults in your synoptic software, it’s important to understand the different available defaults. A robust synoptic software will allow for four different defaults, each with its own unique attributes and uses.

  1. The most basic and widely used defaults are global defaults, and they apply to every report without exception.
  2. Physicians or practitioners tailor personal defaults depending on the particular needs and trends of their individual practice or clinic.
  3. Conditional defaults are dependant on other values, and are similar to conditional logic and branching. These defaults apply only if another value is specified. As an example, the software could conditionally default organ selection to prostate for males or ovarian for female patients during cancer screening.
  4. Dynamic profiling creates defaults based on the most common answer to particular questions in specific situations. For example, if the software detects that the answer to a given question has been been the same in 90% of recent cases, it may begin to use that answer as a default.

Best Practices for using defaults in your EMR.

There is absolutely no one-size-fits-all solution when it comes to using defaults. Every practice is going to use different defaults depending on its specialisation and trends. Maximising the efficiency of your synoptic software without compromising accuracy depends on following important guidelines.

Err on the side of safety.

One of the key benefits of synoptic reporting is that it improves accuracy and reduces medical errors [3]. Electronic synoptic reporting is especially helpful for reducing medical errors. Mandatory questions ensure that relevant data are always present in the report. Synoptic software also records information in a specific and consistent format. Using default answers, on the other hand, creates the possibility of introducing the very medical errors that synoptic reporting seeks to eliminate. That’s why it’s critically important to evaluate each question on a synoptic report to determine if it’s a good candidate for being answered by a default, and if doing so will create the possibility of an error in the report. If there’s any doubt, err on the side of safety and avoid the default.

Review defaults and pay attention to exceptions.

Using defaults may help speed report completion, but they also carry with them a risk of complacency. Just because a question has been answered by a default doesn’t mean it shouldn’t be given due consideration during the reporting phase. It’s important to develop a habit of reviewing default answers and asking yourself whether any given case is an exception to the default. Otherwise the default answer may be introducing unintended errors into the report. Regular review of your defaults and being aware of exceptions are both crucial to the effective use of default answers.

Set high thresholds for dynamic profiling.

Dynamic profiling has the potential to improve the efficiency of your electronic synoptic reports, but it requires careful implementation. Set high thresholds for when an answer becomes a default, and use rules to ensure that the responses are valuable. For example, in addition to an answer being the same in at least 95% of past cases, you may also want to define that the threshold must have been reached within the last 20 cases. The rules for dynamic profiling can be incredibly sophisticated, so they may require some time and effort to configure properly; however, taking the time to get them right can be valuable if you’re able to simply review entire branches of a report instead of having to fill them out again and again.

Give individual physicians control over defaulting patterns.

Bone marrow screening personal defaults in Synoptec EMR Software
An example of personal default configuring in Synoptec for bone marrow cancer screening.

Individual physicians are the ones filling out the reports, and are the ones who best understand their reporting habits. They’re the ones who will best know what questions are most suitable for receiving a default answer and what that answer should be. This is where personal defaults are valuable; a good synoptic reporting software, like Synoptec, will allow every practitioner to define the default answers most useful to them.

Avoid setting defaults on safety items. Ever.

Defaulting answers can speed the reporting process, but there are some questions simply too important for defaults, particularly in surgery. For the safety of patients (and to manage medical legal liability), never default questions about safety items such as sponge and needle counts. The risks and consequences of miscounting or misreporting are simply too high.

Setting the appropriate defaults for a practice’s reports can help save time, further adding to the value of electronic synoptic reporting. However, doing so requires care and consideration to ensure accuracy. By paying close attention to the defaults available in your synoptic reporting software, and how to best implement them, you can achieve greater efficiency and faster reporting without sacrificing patient care or quality of outcomes.

References:

  1. Larson DB, Towbin AJ, Pryor RM, Donnelly LF. Improving consistency in radiology reporting through the use of department-wide standardized structured reporting.Radiology. 2013 Apr;267(1):240–250.
  2. Donahoe L, Bennett S, Temple W, Hilchie-Pye A, Dabbs K, Macintosh E, Porter G. Completeness of dictated operative reports in breast cancer–the case for synoptic reportingJournal of Surgical Oncology. 2012;106(1):79–83.
  3. Lin E, Powell DK, Kagetsu NJ. Efficacy of a checklist-style structured radiology reporting template in reducing resident misses on cervical spine computed tomography examination. Journal of Digital Imaging. 2014 Oct;27(5):588–93.