A tex based engine used to make internet life easier. It triggers user defined links like favorite websites, maps, youtube videos, recipes. The user saves on time and # of computer keystrokes.
During the 1st peak of the covid19 pandemic our Phrasefire Medical doctors noted the severe shortage of hospitalists to treat patients. Text based templates enabled well-meaning psychiatrists, pediatricians, orthopedic surgeons and others with no infectious disease experience to step in and function as hospital doctors. This experience showed us the possibilities of simple text templates based on if/then statements. For example “If +covid19, hypoxemic, no liver or renal failure, give remdesivir order set.” This time saving technique can be used outside the hospital too.
Type simple key words into the text field. The user defines what information populates when the key words are typed, similar to tags on social media. For example, paste the Google Maps links to your 3 favorite pizza spots into Phrasefire. Also your 2 favorite pizza recipes, and address of your favorite person to eat the pizza with. All will populate just by typing the word "pizza."
We came up with this program because doctors spend more time with the computer than with actual patients. Our doctors at Phrasefire Medical are seeing 21.5 minutes saved per 10 patients admitted or seen in clinic. Assuming 7 on/ 7 off hospitalist schedule and 182 day work year this equates to 3905 minutes = 65 hours = 2.7 days/year. What would you do with 3 days saved every year?
Assessment subsection contains 5.16 sentences
on average (Table 1)
https://aclanthology.org/2021.acl-long.384.pdf
5.16 * avg sentence length (words) 12-17 words per sentence in scientific articles, similar subject matter to medical note =
61.92 - 87.72 words in the sentence. Typically assessment/plans are much longer than 12-17 words.
https://www.aje.com/en/arc/editing-tip-sentence-length/
https://www.elsevier.com/connect/writing-a-science-paper-some-dos-and-donts
88 words * avg typing speed https://www.ratatype.com/learn/average-typing-speed/
88 words 88/*41 wpm for avg computer typist = 2.15 minutes per note saved
In a 10 pt admission day, that is 21.5 minutes saved. Assuming 7 on/ 7 off schedule, 182 day work year this equates to 3905 minutes = 65 hours = 2.7 days/year
in summary:
Average length of Assessment/Plan
https://aclanthology.org/2021.acl-long.384.pdf
Extrapolated average assessment/plan length from the average sentence length in scientific documents
https://www.aje.com/en/arc/editing-tip-sentence-length/
Average typing speed
Third highest cause of death in the U.S. is medical error.
10 percent of all U.S. deaths are now due to medical error.
Medical errors are an under-recognized cause of death.
https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
It depends on the size of the medical center. We extrapolated the data from the David and Kaplan study to the largest healthcare provider in Southern California at 4.7 million members. This hospital system likely sees up to 14100 medical errors yearly at a cost of $13,239,900/year. Cautious estimates of a 10-20% reduction in hospital-based error using PHRASEFIRE suggest a savings of 1410 - 2820 errors yearly, saving approximately $1,323,990 - 2,647,980.
A healthcare system serving 1 million patients would likely save between 141-282 errors yearly at a cost of $132399 - 264798.
https://www.sciencedirect.com/science/article/pii/S1098301512042660
The website works with mobile devices, but is optimized for desktop use. That is where the bulk of our typing data is in input at our hospital.
Patient sensitive data is not input into our system. We instruct users to paste the HPI without any patient identifiers such as age, sex, name, location. Any data input into the system is used to trigger a display of user-generated assessment/plans. It is not saved or analyzed in any way.
Users are encouraged to save EBM articles directly in the assessment/plan. Reminders, notes, treatment considerations are good candidates for this.
By having evidence-based medicine articles directly linked to the assessment/plan as well as the ability for the attending to set specific plans for diagnoses, it is likely that this is the end or at least a reduction in the practice of “pimping” known all to well in our medical establishment.
