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Soapnote - shared evidence in clinical practice

Applicants: Mark Morgan
Affiliation: None currently - Seeking endorsement of affiliated organization
CC affiliated? Yes
Contact: Mark Morgan
Coordinator: Mark Morgan
Project Start: 2010/08/01
Project End: 2011/07/31
[[Media:|Download budget]] Discussion

Describe the project you are proposing as clearly as possible in just five sentences.

There is a race on. Nearly every health organization in the United States is racing to adopt an electronic medical record-each with it's own standards. Unfortunately, each new proprietary system that is developed also locks away valuable tools that medical providers use in their day-to-day practice. An open forum for sharing of these tools, specifically clinical decision support and documentation templates (as well as the evidence that supports them) is urgently needed.

Detail the tangible project output (e.g., paper, blog post, written materials, video/film, etc.; this would be in addition to the final written report that successful grant recipients will be expected to deliver to CC at the conclusion of the project).

Blog posts containing interactive clinical documentation templates and calculators produced on the site. Posts with annotations of medical evidence. Rights attribution for all content.

Describe the community you are targeting. How would the project benefit the community?

By empowering health care providers to share the clinical decision rules, documentation templates, checklists, and boilerplate, these tools will improve. As this tools improve, the delivery of healthcare for all will improve, as />

What is your relationship with the community you are targeting? Why are you the best individual/organization to lead this project? Do you have prior experience in related projects?

I am a Family Medicine physician working for the Indian Health Service. I have been working on this issue on my spare time since January 2009. I have previously worked as a computer programmer at the Centers for Disease Control prior to becoming a physician. I believe I am uniquely suited to create a resource that will improve healthcare delivery and exchange of knowledge.

How will you measure and evaluate your project’s impact - on your main participants? Other contributors? On the larger community?

I have encouraged physicians at academic medical centers to test the use of the website. It could be compared against their current practice in controlled studies OR simple usability questionnaires such as the System Usability Scale (or other measure) could be employed. Objective usage statistics may include number of published posts, feedback, ratings, and comment counts.

How many participants do you expect to be involved in your project? How will you seek and sustain their involvement?

For the development of the web site as a forum for exchange of information, I will be the sole developer. Regarding the development and exchange of shared content, I will solicit input from the wider primary care community via Twitter, Facebook, Delta Exchange (a web community of the American Association of Family Physicians), and doc2doc (a web community of the British Medical Journal). Collaborative features of the website will encourage their involvement and I hope the tools available on the website will recruit new users.

Describe how your project will benefit Creative Commons' mission to increase the amount of creativity (cultural, educational, and scientific content) in "the commons".

I feel very strongly that it is very important that clinical tools are not sequestered into proprietary systems. Just as there are currents driving the exchange of research information, there are also economic forces driving content to locations where it can be monetized. Ultimately, I feel that the overall trend for scientific knowledge is toward openness. In this specific case, however, the government's very humanitarian goal of encouraging adoption of electronic medical records works against openness in some ways. The mad dash to obtain electronic efficiencies at the clinic level may have the effect of interfering with information exchange between providers. By providing an alternative such as the forum at, I believe the exchange of clinical documentation templates and calculators will be more open.

I feel that it is not the intention of many authors to reserve all rights when they publish their work - it is simply an issue of convenience or a lack of awareness. An important goal of my site is to encourage use of the Creative Commons' licensing tools to prompt creators of clinical content to consider sharing their works more freely at the moment of publication.

If these templates, really only a small increment of clinical knowledge, are moved into a realm of openness and free exchange, I think the impact could be tremendous to the Creative Commons mission. Two reasons for this: 1) Visibility: these templates are what clinicians are looking for at the point of care; and 2) Universality: at the very most fringes there are differences, but ultimately the practice of medicine is a common practice to all communities. Opening medicine up to the Commons improves healthcare for all.

Describe what technologies and tools your project will use. What kinds of technical skills and expertise do you bring to the project? What are your technical needs?

I do have some experience with computer programming (PHP, Python, Visual Basic, SQL Server), but I will try to keep this project as simple as possible by using Wordpress blogging software (open source) and available plugins. Where needed, I will employ some PHP code. Where coding or design is needed that is beyond my capability, I would like to use small contracts with professional programmers to accomplish necessary fixes and updates as they are needed. As an open-source project, I would be pleased if anyone would like to adopt or modify the technology I've developed for their own use to improve collaboration in medicine.

One new technology under development that I hope to use is the CC Wordpress Plugin ( which will allow users to license content on a by-post basis.

What challenges do you expect to face, and how do you plan to overcome them?

I am certain that there are multiple challenges that I am not anticipating. First, I think there may be obstacles to contributors asserting any control of rights over the content they are authoring. Whereas many institutions encourage authors to have their works published, this seems to evaporate at the interface of formal publication vs. blog. By clarifying the issues surrounding this, a more favorable environment for information exchange will result. A second challenge will be simply encouraging adoption of the tools. Not all medical providers are technologically savvy, but these are the people who I want to recruit to use the web site to build the content for open use: clinical documentation templates and calculators. I will try to overcome this obstacle through discourse in online forums as well as by performing live demonstrations wherever I can and by posting video demos and tutorials to the web to ease the learning curve.

How do you plan to sustain your project after the Creative Commons funding has ended? Detail specific plans. How do you plan to raise revenue to continue your efforts in the future?

This project will not use advertising to produce revenue to continue the project. I will use two mechanisms to cover the costs of future development and web hosting. For the cost of future development, I will use the donation site, or similar fundraising tools to help defray costs. For the cost of web hosting, my web hosting service, Dreamhost, has provided me with a link to request donations that will go directly to web hosting costs.

From a practical standpoint, web server costs will be kept as low as possible. There is no need to carry video or audio (beyond tutorials) and the overwhelming bulk of data at the site is simple text.

Ultimately, I think government, industry, and trade groups may someday embrace the idea of standards and exchange in clinical templates and calculators. For now, they do not. There are no such entities with an interest in supporting this project and my financial resources are far more limited than my time. Financial support would help "seed" the project and build momentum, which I believe would be self-perpetuating.

How can this project be scalable, or have a scalable impact?

Any provider in any clinic on the planet who has unfettered access to the internet will also have free access to this web site and its content. All data is managed via the Wordpress platform. By employing this mainstream, open-source, time-tested web framework the project is assured safe growth of the data on which it depends. And, as users contribute content, the site will become more valuable as a reference.

Because the site is intended as a gesture towards openness in the exchange of medical knowledge, I will encourage free adoption of this technology by other sites. Hypothetically, it is possible that certain communities, specialties, and provider groups may want to have more limited (or different) scope than, so I will work to accomodate anyone who is interested in using the technology developed for the site.

Finally, since my fear is that hospitals and other medical systems are adopting insular documentation templating schemes, I will always ensure that it is an easy alternative for them to contribute and retrieve templates at the website. My hope is that this open alternative will become apparent and gain momentum.

What resources and support do you expect Creative Commons to provide to your project to ensure its success (if any)?

I would like to be able to clearly encourage users of the web site to employ Creative Commons licenses to the content they contribute to the site.

Describe how your organization currently communicates with its community members and network partners. (100 words)

RSS feed, Email, Twitter, Facebook, and the web communities of several professional societies.