By Brittany Behar, MD

How do you feel about electronic medical records (EMR)? If you’re like me, you love that you can access notes from across institutions and see other physicians’ patient assessment from virtually anywhere in the world. It also allows for retrospection, for physicians to review patient outcomes, and evaluate the efficacy of interventions and treatments. Many clinical data have been generated over the past decades through this manner. But this can leave questions of whether those conclusions are broadly applicable due to lack of standardization in documentation.

The International Consortium for Health Outcomes Measurement (ICHOM) recently published “A Standard Set for Outcome Measurement in Patients with Hand and Wrist Conditions: Consensus by ICHOM Hand and Wrist Working Group” in The Journal of Hand Surgery. The group set out to create standards for measurement of outcomes in adult hand and wrist surgery based on the location of the injury (thumb, finger, wrist, etc.) and the severity of the injury (basic, extended, severe trauma). Through Delphi technique and real patient survey, they developed standard assessment measurements (grip strength, arc of motion, pinch strength, etc.) and patient outcome/well-being surveys.

One of the main discussion points of this paper and concerns that I considered is that these evaluations may become protocols required as part of value-based health care delivery. If they become required, is it feasible to implement these measurements into a busy hand clinic on a daily basis? If so, how can we make this transition less painful? This is where electronic medical records can be useful. Delete all the note bloat and create a universal hand and wrist physical exam form that includes these evaluations, prompts the surgeon to measure and assess them, and makes the data accessible to all.

This would make our notes more useful, more translatable, and would pool the power of outcomes across health care systems. This would ultimately lead to better outcomes research enabling physicians to have more informed discussions with patients about what to expect after a specific injury, intervention, or surgery.

Reference:

Wouters RM, Jobi-Odeneye AO, de la Torre A, Joseph A, the ICHOM Hand and Wrist Working Group, Hovius SER. A standard set for outcome measurement in patients with hand and wrist conditions: consensus by ICHOM Hand and Wrist Working Group. J Hand Surg Am. 2021;46(10):841-855.