An FP’s quest for meaningful medical document titles
Frustrated by disorganized EMR inboxes, Dr. Ian Bekker championed a standardized solution in B.C. using LOINC and is now advocating for its adoption across Canada.
The following story was originally published in the Medical Post’s Doctor Daily newsletter on June 19 and is republished here courtesy of the Medical Post. Dr. Ian Bekker, who was interviewed for this story, was a speaker at the June 1-3 e-Health25 Conference in Toronto.
By Norm Tollinsky
Dr. Ian Bekker, a Victoria, British Columbia GP specialist in geriatrics used to spend valuable time retitling documents from hospitals that landed in his EMR inbox. “No one had stopped to consider what title would show up in our inbox or in the patient’s chart, so we were getting useless titles like ‘document,’ or ‘consult,’ or a jumble of characters that meant something to a computer but didn’t mean anything to a physician,” he complained. “It’s important to be thoughtful about document titles, because they allow doctors to scan through their inbox or patient chart and find what they’re looking for.”
Because document titles weren’t clear or sufficiently descriptive, family physicians would open each one and retitle it, wasting time every day.
Armed with two engineering degrees and several years of related experience prior to entering medical school, Dr. Bekker had a special interest in health information technology. As Island Health’s primary care informatics lead from 2016 to 2020, he succeeded in lobbying for a solution using the LOINC standard to classify hospital documents and present a meaningful title for recipients.
Having played a key role in solving the problem for British Columbia, Dr. Bekker is now intent on introducing the solution to the rest of the country. To that end, he spoke on the subject of document classification at the recent eHealth25 conference in Toronto June 1 to 3.
LOINC (Logical Observation Identifiers Names and Codes) is a standardized system for identifying laboratory and clinical observations to help ensure accurate and interoperable exchange of clinical data. The standard was developed by the Regenstrief Institute in the U.S. and is freely available worldwide.
Family doctors consulted about document titles told Dr. Bekker they wanted to see the discipline and the document type. “LOINC offered us, as an example, ‘Cardiology Attending Hospital Consult,’ but doctors said ‘No, all we want is Cardiology Consult.’ In some cases, the titles were further abbreviated, so instead of ‘Dermatology Consult,’ it’s ‘Derm Consult’ to fit in the limited space for document titles in EMRs, so we used an international standard, but we adapted it for B.C.”
When Dr. Bekker goes to his EMR to write a note, he selects ‘Geriatric Medicine Consult,’ but when it lands in a family doctor’s EMR, it’s the short form of the title – ‘Geri Med Consult’ – that shows up. The LOINC code 34776-5 for geriatric medicine consult notes is associated with both the long and short titles as well as additional metadata. The B.C. document title list includes a total of 1,600 LOINC codes.
Of the five health authorities in B.C., the Vancouver and Island authorities have fully adopted the LOINC standard. The Fraser Health Authority, B.C.’s largest, is 20 to 30 per cent complete, while adoption at the Interior and Northern authorities is progressing more slowly.
“In order for a library to work, you need a classification system,” said Dr. Bekker. “It’s no different for a healthcare system with hundreds or thousands of documents. Getting information from a patient’s chart with a lot of documents is complicated because EMRs aren’t particularly good at filtering, sorting or finding, so you’re left with doing an eyeball scan to find the information you’re looking for.
“There’s no search field in the EMR to find ‘Dermatology Consults,’ for example. Isn’t that amazing? The public is really surprised about that. Because we haven’t classified the documents, we have no classification system. It’s a giant library with no numbers on the spine, no card catalogue to look things up and no Control F to find things.”
According to Dr. Bekker, we are not that far away from family doctors and specialists sending digital documents to each other through their EMRs instead of faxing them. “This emphasizes the importance of having a Canadian standard for how documents are sent,” said Dr. Bekker. “Hospitals have whole teams of health information management professionals keeping clinical documents organized. We don’t have such teams to keep community documents organized, and document standardization and classification isn’t on the interoperability roadmap,” he complained.
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