The Chief Complaint, History, and Physical
Chapter 1 Bedside Questions · 8 questions · about 8 minutes
Technology decisions are driven by vendor capability, IT initiative, regulatory mandate, executive impulse, or competitive anxiety instead of a clinical question, which degrades the clinical encounter. The damage follows a predictable cascade: build decisions become cognitive load, then safety risk, quality drift, financial loss, and permanent unwarranted variation.
The chief complaint and the history and physical: the degraded clinical encounter is the presenting symptom, and no one took the history or examined the patient before prescribing technology.
Answer as your executive team would, with the evidence in hand. Each question has a factual answer in a system you already own.
Does your organization require a documented clinical priority before any technology feature is activated or configured?
Add a note: where is the evidence, or who owns it?
Who governs clinical technology decisions? Is it a physician with formal informatics training and explicit authority to stop, modify, or require a deployment?
Add a note: where is the evidence, or who owns it?
For your three largest technology investments of the last five years, can anyone state the clinical outcome each was meant to change, and whether it changed?
Add a note: where is the evidence, or who owns it?
When did your organization last decline to deploy a technology because the clinical case could not be made?
Add a note: where is the evidence, or who owns it?
Can you trace a direct line from EHR configuration to quality metric performance?
Add a note: where is the evidence, or who owns it?
How much do you lose annually to documentation-driven coding deficiencies, inaccurate risk stratification, and denied claims eventually paid? Have those three figures ever been put on the same page?
Add a note: where is the evidence, or who owns it?
Does your organization track health-IT-related safety events as recommended by the SAFER Guides?
Add a note: where is the evidence, or who owns it?
Is a clinical informatics leader a voting member (not an invited guest) at strategic planning and quality governance tables?
Add a note: where is the evidence, or who owns it?
A reflection tool from the book, not a validated diagnostic test or benchmark. Your answers and notes stay in this browser unless you choose to send them. Please don't enter patient information.
The instrument is already bought. The missing link costs a fraction of that.
The Diagnostician, Chapter 1