I hate repeating myself. But that’s what I do all day long. I’m stuck in the time loop and I'm desperately looking for a way out.
So when we invested big bucks in that new EMR (“the groundhog”), my hopes were high it would address the repetitive stress injuries. At least that’s how they sold it to us, physicians. If I remember well, the salesman’s Powerpoint said something around the lines of: “the groundhog relieves physicians of having to perform repetitive sequences that are unrewarding and for which human beings in their inconsistency can be at their best or their worst.” Well said. But 45 hours of training and a bumpy go live later, we all woke up to “I got you Babe.”
“I got you to love me so”
Since EMR vendors don’t understand crap about clinical documentation, they have no idea what theirs groundhogs put us through. So many repetitive sequences and default data could be automated right there, so much data could be inherited, and so many errors avoided. But hell again, no.
The other day, a bunch of ghosts were laughing their heads off at a poster-size printout of the “Report of the month”. Demographics had been blurred and the first sentence increased to a size 50 font. It said: “89-year-old pregnant woman.” Nice one.
The fact that such reports go through dictation, transcription, sign off and distribution without a glitch would have be funny back in 1985. Because all there was back then were human beings and errare humanum est. But in 2012, it makes me want to call Mamma and cry. Because we just paid 30 million for a system that can’t even automate the most mundane of repetitive text blocks using data that’s already been entered in the system with equal pain.
“With you I can’t go wrong”
Since the hospital uses a wide array of systems for plenty of good reasons and since the groundhog has no clue how to communicate with them, demographics never follow the patient from triage to Radiology for instance. And since more keystrokes plus more frustration equals more errors equals less lives saved, I can hear the “I did not graduate from medical school to become a data entry clerk” song being played in loops on the on-call room’s stereo. Agreed. We're surgeons, not Moby Clicks.
Scary example #1: there’s no way for me to find out whether there was a medication change because of a lab result. And since medication dosage wasn’t super-duper accurate in the first place because hey, good luck with finding patient history inside the groundhog (“Yes, doctor N., it’s 15mg. I think. Wait. Maybe it’s 50mg. Can I call my wife?”), you get my point.
OK let’s say I’ve got the dosage right this time. When the patient comes back in 6 months and I need to reorder chronic medication, I’ll be the one requiring Norset 15mg to go through the hundred-click-process without loosing a precious piece of brains.
But you know what, I’ll increase the dosage to 30mg. Because it’s getting worse.
“They say our love won't pay the rent”
This whole integration twilight zone is bad in terms of patient safety, yes. But it’s also costing you and me big bucks – in addition to the 30 million my hospital’s CIO just cast off to sea. Let’s say I order a chest ray on patient Connor, and his family physician already ordered one 3 weeks ago. Well, there is no way for me to know that. Unless the patient tells me on his way back from the dark room, but that’s not exactly my definition of timely and patient-centric care. All this to say: if we could put a dollar figure on the cost of double orders and triple prescriptions, we would all loose it. In the meantime, what we’re losing is a lot of (taxpayer's?) money.
OK, that's it for now. It’s 6:00 am on the East Coast and the radio’s playing Rage against the Machine.
Cheers from the on-call room,