When I arrived at work recently, I was confronted by the doctor I was relieving who had spent his entire emergency department shift in frustration with the computer system.
It seems that when he signed on, he found himself interacting with an unfamiliar appearing screen. In addition, when he created a note in a patient’s record, he was unable to access and add to the chart later on.
He had called the information services person on duty who had used some computer magic to access the doctor’s screen remotely and could see what the doctor was seeing. Unfortunately, the IS person had no idea what was wrong, so the frustrated doctor soldiered on until I arrived.
While I was briefly baffled by the doctor’s dilemma, I was also “lucky” enough to have found myself in a similar situation before. Therefore, I was able to recognize that for some unknown reason, the doctor’s computer “thought” he was an attending doctor on a medical-surgical floor of the hospital, rather than an emergency doctor in the ER.
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Of course, once the problem was diagnosed, he still needed the solution and had no idea what to do.
Again, since I had fallen down a similar rabbit hole before, I was able to help him navigate the process of returning to the desired context and function. I also realized that the incident was a symptom of a much more serious problem.
The real problem is that we treat computers and the electronic medical record as if they were mysterious black boxes. Many physicians seem to operate on a “need to know” basis and do not really understand how computers and software work or what their capabilities might be. In addition, because there are lots of “options” to choose from, there are many inconsistencies as to what the finished product looks like for each encounter.
If you care to listen, you can hear this lament from practically every medical caregiver who must interact with electronic medical records. You may even hear their opinion as to who is to “blame” for this complex set of problems. However, I doubt that you are going to hear much in the way of solutions.
I believe this will continue along its dysfunctional path for a very long time because the answers will result in more work for the already overburdened people who provide medical care. That is to say, I believe that the answers lie in going back to school.
What I mean by that is we need to have regularly scheduled classes, with homework and deadlines, taught by someone who is well educated in the nuances of the electronic medical record. These teachers must be willing to fill in the gaps that are created by our attempts to “get through the day,” not understanding how and why we might need to interact with the electronic medical record in a particular way.
At present, the electronic medical records are being fed an enormous amount of information from many different sources in such a way that it is all available, but frequently nearly impossible to find in a quick, complete and organized fashion.
This problem is compounded by several factors including that some health care providers use templates and others type their notes while still others dictate to a voice-recognizing program. The fact that many in the last group do not go back and proofread what the computer “thinks” they said not uncommonly results in records that are nearly incomprehensible and sometimes very funny, but certainly not very helpful and possibly dangerous if the information is actually important.
Even though all of the appropriate information is in the computer system somewhere, the disparity of the various input techniques of these bits of information makes them frequently difficult to coordinate into a clear picture of the patient’s history.
I recognize that what I have written here will make you think that I am some sort of Luddite when it comes to computers and their use in medical care. However, I want to make it clear that the opposite is actually true.
My frustration is that computers and electronic medical records have the potential to be much more helpful in the coordination and communication required for the best possible medical care. Because of ignorance and lack of training and oversight, they are being used too frequently as if they were blunt instruments instead of the sophisticated, precision tools that they are.
Since the development of electronic medical records will continue to evolve, I know that education and practice in “best practices” are involved in the answer to these concerns. However, I do not know how to find and participate in that process from the prospective of an emergency doctor, while trying to keep up with the active practice of medical care.
Naturally, not being a Luddite, I have tried to “Google” all of this, but it was not much help.
Date: June 11, 2016