Innovation in digital history taking

History taking is a skill that medical students are taught early in their medical education. Learning to be tactful, polite and yet strike a cordial conversation with the patient is an art form that takes time and experience to nurture. Early in their careers, sticking to a standard template is a safe bet to acquire a complete history. At this stage, conversations with patients may literally be absent. The need to illicit a history may border on interrogation of the patient. As one gains experience, this skill is sharpened and history taking may appear seamless and outwardly mistaken as chatter.

The point is that history taking can vary from one patient to another. The topic of conversation may swing from the current complaint to a description of a vivid experience from years ago. Making sense of them all can sometimes be daunting. Hence, note taking is often peppered with scribblings and arrows, as the conversation with the patient progresses. It often is difficult to “compartmentalise” the different components of the history.

So how can digitisation help in enabling the documentation of the history? Traditional EMRs often is rigid. Doctors have to compartmentalise the documentation based on those digital parameters that had been set. Moving in between the different components of the history and if reorganisation is needed, is close to impossible. This frustration often makes EMR cumbersome and a distraction in the consultation room. It takes away the freedom that maybe the pen and paper, can provide.

A radical idea is needed to transform digitisation of history taking. How can we make it seamless, intuitive, flexible and at the end of it, generate the standard history that is required?

We have some ideas that we wish to share.