title: Instant replay.
abstract: With widespread adoption of electronic health records (EHRs) and electronic clinical documentation, health care organizations now have greater faculty to review clinical data and evaluate the efficacy of quality improvement efforts. Unfortunately, I believe there is a fundamental gap between actual health care delivery and what we document in the current EHR systems. This process of capturing the patient encounter, which I'll refer to as transcription, is prone to significant data loss due to inadequate methods of data capture, multiple points of view, and bias and subjectivity in the transcriptional process. Our current EHR, text-based clinical documentation systems are lossy abstractions - one sided accounts of what take place between patients and providers. Our clinical notes contain the breadcrumbs of relationships, conversations, physical exams, and procedures but often lack the ability to capture the form, the emotions, the images, the nonverbal communication, and the actual narrative of interactions between human beings. I believe that a video record, in conjunction with objective transcriptional services and other forms of data capture, may provide a closer approximation to the truth of health care delivery and may be a valuable tool for healthcare improvement.
authors.affiliation: Yale School of Medicine, New Haven, CT, USA; Homeless PACT, VA Connecticut 950 Campbell Avenue, New Haven, CT, USA. Electronic address: david.rosenthal@va.gov.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
keywords: Electronic health records; Graduate medical education; Quality improvement; Video technology