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,
Doc Tornado
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