On March 21st, 1968 the SOAP note was proposed in an article from the New England Journal of Medicine Medical Records that Guide and Teach.
The SOAP format, popularized by physician Lawrence Weed is the most widely used and simple documentation algorithm in Western medicine.
According to Margalit Gur-Arie, MD at her blog On Health Care Technology:
"Practically every EHR in existence today is based on Dr. Lawrence Weed’s SOAP note format...with the singular purpose of speeding up documentation and ensuring that the finished note is a proper clinical, legal and financial document. And as most of us know only too well, we are not there yet."However, the time for the SOAP note in adult ambulatory physical therapy clinics is over.
The congruence of Electronic Medical Records (EMR)and changing healthcare processes present a once-in-a-lifetime opportunity to improve a paradigm that, in most physical therapy settings, is akin to shoving a square peg into a round hole.
Most of the over 900 EMRs currently in the commercial and federal marketplace use some version of the SOAP format.
Yet, SOAP was originally developed for medical sub-specialty physicians working within the high-cost, acute care hospital to "talk" to one another in an asynchonous fashion.
Asynchronous just refers to the fact that one physician didn't have to actually speak to the other, they could just read each others standardized SOAP notes.
Today, the "killer app" of asynchronous communication is called e-mail.
The birthday of SOAP is convenient in the context of this discussion begun March 16, 2012 on the technological value of paper vs. Electronic Medical Records (EMR) records from the EMR and HIPAA blog called Paper Has Healthcare Spoiled.
The above video, also from the EMR & HIPAA blog, skewers the traditional technology Help Desk that requries every computer/EMR user to need a Help Desk. Healthcare should be easier that this.
SOAP is part of the problem because physical therapists, most of whom practice outside the acute hospital setting, are forced into using the SOAP format. Most PTs still use SOAP written on paper.
According to the EMR and HIPAA blog:
Paper is...While paper has certain, underappreciated, technological virtues SOAP is vulnerable to criticism as a documentation format, especially for chronic health conditions.
"Flexible to an infinite number of documentation methods.
Does paper support the SOAP format? Yes!
Does paper support every specialty? Yes!
Paper has the ability to morph to every medical specialty’s documentation needs."
SOAP encourages a clinical record that is...
- Described from the provider’s perspective only
- Brief and vague
- Focused on the patient’s immediate painful symptoms
- Focused on the provider’s particular treatment
- Repetitive
- Narrative, rather than data driven
SOAP's appeal lies in its universal acceptance rather than its ability to describe the patient experience.
SOAP is easy to teach to students who have been, as the EMR & HIPAA blogpost states:
"Trained in the ... ability to write (which) is near universal thanks to training in doing so since we were children."We should use the convergence of electronic tools and medical documentation as an opportunity. An opportunity not just to decrease paper medical records but also to change the SOAP format and start over using modern tools to describe disabling conditions experienced by our patients.
I bet physical therapists could come up with some good ideas.
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