Untapped

Soapnote was created to address a problem. Calculators, boilerplate, clinical decision rules, and checklists that providers use in their daily practice are often piled into proprietary electronic health record silos (link: http://bit.ly/eLaIRu), personal disc drives, paper forms, and in some cases, paper scraps.

This untapped information has value.  It’s a sigh of relief to find a clinical gem when you’re behind schedule seeing patients.  It’s sleep you can bank on when you’re a resident on call Q3.  And it’s also that much more you can do for the patient sitting in front of you.

A blog of tools

Of course, a SOAP note (link: http://bit.ly/gVpFva) is the form of clinical documentation often used for progress notes.  SOAP is an acronym for Subjective (history), Objective (examination), Assessment (diagnosis), and Plan (treatment) components of the note.

Soapnote is a website intended for use by medical providers to create, collaborate, and catalogue clinical decision tools.  And “Soapnote” refers to any clinical decision tool on the site.  It’s a blog of clinical tools where anyone can post and receive feedback.

Driving principles

The development of Soapnote is guided by some core principles.

• D-R-Y (Don’t Repeat Yourself; link: http://bit.ly/fripkU) so you can focus on duties that require more thought.
• Checklists jog your memory and make care better (link: http://1.usa.gov/fzzcFG).
• Writing computer-based clinical decision support needs to be as simple as possible.
• Medical providers must be able to exchange clinical decision tools.
• The Soapnotes on the website should be compatible with all electronic health records.
• This should be free to use for everyone.

Essential features

• Variety:  It is an online database of generic SOAP note text, web forms, calculators, and other clinical decision tools.
• Open:  Any user may review, edit, and collaborate online.
• Bookmarking: Users can save their favorite content (Soapnotes).
• Voting:  Raters can indicate whether or not a Soapnote was useful to them.
• Commenting: Each Soapnote can also be a discussion.
• Social sharing:  ”Steal shamelessly and share seamlessly” with embeddable widgets.
• Evidence Based:  Soapnotes are linked to and annotated with evidence.

A Soapnote is …

It could be as simple as a checklist or as involved as a paragraph builder with some decision support (including calculations).  Anything that speeds up your clinical visits, makes the care you provide more consistent, solidifies your diagnosis or treatment plan, improves the depth of your documentation, or simply helps you not forget an important step.

Worth sharing

The purpose of Soapnote is to allow providers to spend more of their time thinking about “hard stuff” and less time re-inventing the wheel.  Here are some sources you can use to make good templates:

• import your medical templates from dictation programs such as Shorthand for Windows (link: http://bit.ly/eloP18)
• paraphrase your best old notes
• build from your favorite evidence sources
• collaborate to make templates as an educational exercise
• and any other ways you can think of…

‘Social’ improves things

It’s not quite peer review in the strictest sense, but as of right now (April 28, 2012), the small community of users aware of soapnote.org has expressed an opinion in a few different ways.

Highest Rated 5

Those little up and down thumbs at the bottom of every soapnote count!  Below is the top 5.  You can check the full list at any time by going to the Highest Rated Soapnotes Page.

1. Cough History Rating: 30 (from 34 votes)
2. Generalized Anxiety Disorder GAD 7 Calculator  Rating: 28 (from 28 votes)
3. Patient Health Questionnaire (PHQ 9) Calculator Rating: 27 (from 27 votes)
4. diabetes medications (decision tool) Rating: 24 (from 24 votes)
5. General Adult Physical Exams Rating: 23 (from 23 votes)

Most Favorited 5

Registered users can save favorites and return to them on their own page.  For instance, my page is at www.soapnote.org/author/mmorgan.  To go to your page, just replace “mmorgan” with your user name.

You can see the full list at the Most Favorited Soapnotes Page.  There are a lot more there!  But below are the 5 users favorites the most.

1. Child-Pugh Score for Liver Failure (calculator) – favorited 116 times
2. Wells Clinical Prediction Rule for DVT - favorited 116 times
3. ACCP Stroke Risk Calculator - favorited 112 times
4. diabetes medications (decision tool) – favorited 111 times
5. Charlson Comorbidity Index - favorited 103 times

Week’s Pique (as in ‘piqued your interest’) 5

This is last week’s most viewed pages.  (Whether or not they ended up being favorited or getting votes may be another matter…)

1. General Adult Physical Exams - 115 views
2. Coumadin adjustment calculator - 70 views
3. General Pediatric Physical Exams - 22 views
4. Musculoskeletal Physical Exams - 21 views
5. Acute Adult Physical Exams - 14 views

As you may have expected, there are pages to see most viewed posts of all time and the week’s most viewed posts.

Parting thoughts

What people look at, decide is good, and save for later are three essential takes on any form of content.  My hope since kicking this project off in 2009 was to stir clinical providers to produce content that others could judge as useful (or as a waste of time).

Medical providers live amongst technology, the application of science.  Social collaboration on these tools gets us closer to better tools.  Sharing online helps us apply medical science better.

The challenge going forward is to improve the interface so that the crustiest, EHR-hatingest, old-schooliest doc actually tries to make a Soapnote and succeeds.  But the key elements are here and there seems to be a hunger in the medical community for it.  And I’ll keep working on it.

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New Soapnotes!

Since the last update (March 2012) I’ve added a few templates and calculators.

1. Obesity Surgery Mortality Risk Score.  The benefits may be obvious to the patient, but this calculator helps illuminate the risks.
2. Edinburgh Claudication Questionnaire.  Use subjective symptoms to help diagnose peripheral vascular disease.
3. Pneumonia Severity Index.  An addition to the growing list of pneumonia tools on the site.  This calculator helps to determine mortality risk.
4. Hearing Handicap Inventory.  A questionnaire to help a patient determine the impact of hearing loss on their life.
5. Asthma Control Decision Tool.  For monitoring patients taking long-term control medication.  This is from the NAEPP 2007 Guidelines that everyone is already using.  If you click on the box next to “display asthma treatment steps,” it will do just that.
6. Generic Asthma Symptom Control Questionnaire.  It’s not validated, but it’s also not copyrighted.  It came straight from a 1995 NIH pocket guide.
7. Classification of Asthma Severity.  For determining severity of asthma in patients NOT taking long-term control medication.  There’s an asthma theme this month!  This is also from the NAEPP 2007 Guidelines.  It can also display the asthma treatment steps.
8. CHF Exacerbation 30-day and 1-year Mortality Rate Decision Rules.  A mortality calculator to help guide decision making for congestive heart failure exacerbations.
9. Lee’s Revised Cardiac Risk Index.  This helps determine the risk of complication following surgery.
10. Rouan Decision Rule for Myocardial Infarction.  This can help to determine the risk of MI for patients with a normal or nonspecific EKG.
11. Diagnostic Rule for Gouty Arthritis.  For some reason a joint fluid analysis just isn’t in the cards today.  This decision tool only requires some subjective and objective exam findings and a blood sample.
12. Diehr Rule to Diagnose Pneumonia.  Another pneumonia decision tool.  For this one, you’re not trying to figure out the mortality rate.  You’re still on the fence for whether or not the patient even has a pneumonia.  Baby steps.
13. Yale Observation Scale for Febrile Child.  This produces an incidence of serious bacterial infection.
14. Multi-Axial Assessment for Psychiatry.  I just needed something to calculate the Global Assessment of Functioning (the 1 to 100 score).  I added in the I-IV because it V looked like it had a personality disorder just sitting there by itself.
15. BODE Index for COPD Prognosis.  It doesn’t give you a mortality, but does give you a consistent way to approach COPD patients.
16. Cough Exam.  I got some (concise) feedback from a user who had viewed this Soapnote.  This was an attempt to add a little ‘O’ to the ‘S’.  There’s also some ‘A & P’ here.
17. Otitis Media Exam.  This was just an attempt to get some more SOAP templates out there.
18. ABCD2 Score for CVA Risk after TIA.  A nice tool for secondary prevention for patients with cerebrovascular disease.
19. Osteoporosis SCORE estimation.  The FRAX tool may be better, but this might be quicker.  (A dubious distinction, but at least you can paste your output into your note with this one.)
20. International Index of Erectile Function Questionnaire.  Probably not one you’ll use every day, but helpful when you’re trying to keep things consistent and as objective as possible.
21. DIRE Score for Appropriate Opioid Use.  This is quite useful.  I’ve used it multidisciplinary settings to guide the discussion a little bit.

Other Good Ideas!

1. Read the User Guide:  For the basics, start with the introduction, it goes from simply using the website to the basics of making forms and calculators.  The key to the most powerful calculators and decision tools is the web form capability.  So there’s a primer on making web forms on the site.  The last section is all samples.  Sometimes just looking at an example is the best way to get started or getting past a roadblock.
2. Use it for customized patient education materials.  I’ve been using the refrigerator notes for a while.  I think there may be a lot more opportunities to provide patients with custom-tailored handouts to help motivate them to improve their health.
3. Give me a suggestion.  If you’ve got a suggestion for a soapnote or an idea for a new way for people to use the site, let me know.  If there’s anything I can do to help, I’d love to!   Just email me at mark@soapnote.org.

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Bookmark this Soapnote

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Bookmark this Soapnote

Add to favorite soapnotes

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Bookmark this Soapnote

Add to favorite soapnotes

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Bookmark this Soapnote

Add to favorite soapnotes

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Bookmark this Soapnote

Add to favorite soapnotes

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Bookmark this Soapnote

Add to favorite soapnotes

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Bookmark this Soapnote

Add to favorite soapnotes

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BEGIN: There are two calculators, one for 30-day mortality rate and one for 1-year mortality.  Click on the appropriate link below to select which calculator.

CHOOSE: 30-day CHF Mortality Calculator or 1-year CHF Mortality Calculator

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30-day CHF Mortality Calculator

1-year CHF Mortality Calculator

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