Love the topic. Very near and dear to my heart.
Q: Should we have a "special documents" "section" ? A: short answer: Probably Yes ! (I definitely agree with your concerns Re: too many sections, you worry about changing the program so many times and I worry that with so many sections to look and browse in ... documents/information will be missed !)
I think the first question that needs to be thought out is what information would go here, what end user flexibility would suit endusers. As well, where whould the tab be ... Tab ? or Popup ? Both ? Subtab under Results ? (subtab under results is probably the best spot, I reckon)
Regarding naming of the Tab, I'd say we need to more generic than Results, say ... Data ? Certainly Doc Man doesn't have the right flavour as there are parsed HL7 results and Vitals data in there ! :)
As I amass a Plethora of Text Results on some of my more challenging patients I do feel the need for some more organization of the data. I just counted on one patient and in one calendar year she amassed 70 items ! 64 of them since January. Certainly you don't make rules based on exceptional situations but it does highlight that as charts get bigger, most EMRs fail to show *THE KEY* stuff. When the boring orbital xray done pre-MRI to rule out any metal fragments in an eye is given the same importance in the EMR as the MRI showing a glial cell tumor you know your EMR is plain jane. After the orbital xray is negative, you really never want to see it again. The MRI you quite likely will want to refer to again. The idea is always the excess data is just distracting and likely contributes to medical errors / problems managing information.
Of course our [Archive] [De-] buttons really show Synapse is ahead of the curve here. I don't know for sure but I am not sure any EMR I have seen has any [Archive] [De-Archive] features ! Sadly EMR purchasers don't think about how bloated and crappy their EMR will look like in 5 years. Rightly so, it's anyone's guess if their vendor will be around that long ! or that their practice situation won't change and will need an EMR change anyway. Welcome to 21st century medical information management.
The even bigger key is that bloated information everywhere that is not sortable and manageable is certainly bad for the doctor but it's even WORSE for the locum or part time staff (nurses, nurse practitioners, MAs) whom don't have the luxury of knowing the patient well. They have to rely on the chart more than the patient's doc and that is a challenge fo the EMR. There are many medical advantages for the patient when their core medical information is readily accessible/presentable to many different providers.
Certainly the future of Medicine / Primary Care is the multi-provider environment.
I am going to take more time to think this through before I make some more suggestions here. I've been thinking about it a long time and I want to get it good and sorted out.
I would point out an interesting slip of the tongue for you ... you said that documents could be tagged .. but they can't only consults ! I think your slip up was a premonition. :) As I have said before, I am bullish on Web2.0-NextGen-EMRs-having tags.
