Land of a Thousand Words

I've spent some time recently working with our new ED information system vendors on verbiage.

That's what the industry calls the result of all the boxes we check when filling out an electronic chart. Those checked boxes develop into a narrative, with the help of software:
The patient's chief complaint is abdominal pain. The onset was described as gradual. This episode began 6 hours ago. The problem is localized to the RLQ. The complaint is associated with fever and nausea and vomit. This is no association with diarrhea or constipation. The problem is persistent. 
Chekhov, it ain't. But there's a lot of pertinent positives and negatives that need to make it into the record, from a galaxy of possible complaints, modifying factors, and associated symptoms. I'm not aiming for art; just trying to maintain subject-verb agreement (though some phrases have had a certain poetry -- my favorite so far is, "The presence of foreign bodies is uncertain.")

Some thoughts on this process:

  • I will generate more chart verbiage than I could ever match with research publications, columns, blog posts and tweets. By this metric, I am finally a prolific writer (though my compensation per word is probably below industry standards). 
  • The (considerable) amount of time we're spending on the verbiage is still not nearly commensurate with the amount of times we'll see it (even understanding that any single chart is unlikely to ever be read again once the encounter is over, the phrases will come up over and over, in multiple encounters).
  • While it's regrettable that circumstances force me to decrease the signal-to-noise ratio in our charts, I consider it worthwhile to try to make the noise a little less jarring.
  • While there are a lot of ED metrics worth streaming to the web or twitter (wait time, chief complaints for biosurveillance stats) I would really enjoy seeing (deidentified) brief excerpts -- sort of like @GiggleMed but artful.  
Does your EMR have any noteworthy stock phrases? Good or bad? I think we'd be happy to cite your system as an influence.