Breaking Free from SOAP—Why EHR Documentation Needs to Reflect Clinical Complexity
The Problem with the SOAP Standard in EHRs
Most EHRs enforce a single documentation format—the SOAP note structure (Subjective, Objective, Assessment, Plan). This format, while once revolutionary, now feels like a straightjacket. Born in the era of paper records, SOAP was useful for its time, but as we moved to digital platforms, we missed an opportunity to rethink documentation to meet the realities of modern clinical care.
For multi-problem visits, SOAP’s limitations become clear. Here’s the workflow most clinicians face:
• Subjective and objective data are mashed together, making it hard to see how each problem unfolds individually.
• Assessment sections often end up as a list of problems without individual assessments or clear next steps.
• The entire structure doesn’t reflect how clinicians actually think, work, or need to manage complex patient care.
The result? Clinicians end up documenting in ways that serve the EHR, not the patient.
How SOAP Falls Short for Multi-Problem Documentation
Many clinicians are forced into documenting in ways that aren’t ideal. Here’s what often happens:
• Subjective and Objective Overload: EHRs require everything subjective (patient-reported) and objective (clinical data) to be lumped together, regardless of how many different problems are being discussed. For a clinician managing multiple issues in a single visit, this becomes a cumbersome, mashed-together section that doesn’t let them easily see what pertains to each problem.
• Assessments Become Lists: Most EHRs only allow space for one “assessment” section, which doesn’t make sense for complex cases. Each problem ideally requires its own assessment and plan, but EHRs force clinicians to simplify, often reducing the assessment to a bulleted list of problems with no room for individualized notes.
• Loss of Problem-Specific Focus: When multiple problems need to be addressed, a single SOAP structure fails to capture the nuances of each issue. For example, a patient with diabetes, hypertension, and depression needs a different approach for each problem. But when the documentation structure is rigid, it becomes impossible to organize the note in a way that mirrors clinical thinking.
The Opportunity We Missed with EHRs
As we transitioned from paper to digital, we had an incredible opportunity to rethink documentation. Instead of reimagining how information could flow based on clinical needs, we simply digitized an old system. The result is that EHRs remain rigidly structured, failing to adapt to both clinician and patient needs. We could have moved toward a flexible, adaptable structure—one that would allow clinicians to document by problem or even adjust based on patient complexity and care needs.
Moving Toward Flexible, Problem-Oriented Documentation
What clinicians truly need is flexibility—a system that lets them document based on clinical reality, not based on the limitations of outdated workflows. Imagine an EHR that:
• Allows subjective and objective data to be structured by each problem, creating clarity for review.
• Enables separate assessment and plan sections for each issue, so that each problem is individually managed.
• Lets clinicians adapt the structure of the note to fit the patient’s needs rather than sticking to a rigid framework.
At River Records, we’re working to make this vision a reality. We believe that documentation should support clinical thinking, streamline workflows, and above all, empower clinicians to manage the complexity of patient care without the constraints of a single, outdated format.
A Call for Change
Documentation should serve patient care, not billing or outdated paper workflows. It’s time to design tools that are flexible, problem-oriented, and aligned with clinical complexity. At River Records, we’re not just digitizing notes; we’re building the future of documentation that reflects the real needs of clinicians and patients.
