On choosing an electronic medical record

Medica record privacy is a concern most of us should dispense with.

The electronic medical record so far is fractionating your medical information making the former mostly complete paper chart the envy of most hospital based practitioners.

At. this children’s hospital we have multiple non-integrated electronic medical charts.
These include emergency medicine, peds intensive care, nursing documentation on the regular wards, inpatient lab/x-ray and physician documentation, OR/anesthesia documentation, and soon to exist, computerized physician order entry. None of these systems talk with each other. I do not have access to all systems and will not for the forseeable future. For those systems I can access, I can do so only serially, logging into one requires logging out of another. Gathering a comprehensive understanding of a patient’s even brief stay can be a daunting challeng.

The reality is I know less about my patients now than I did a year ago because some information is inaccessible to me within my own hospital, and other information is burdensome enough to obtain that I forgoe seeking it in the interest of time. Within the operating rooms there are no computer terminals that can access any portion of these chart fragments, so in this critical care area, my understanding of the patient’s health is what they personally have been able to tell me in the minutes before their operation.

I complain to the chiefs of staff, and hospital administration without effect. Recalling the wisdom of my chief resident from 15 years ago, ‘never drown alone’ when the shit hits the fan in medicine, I duly document in my portion of the medical record which portions of the patient’s chart was available to me and which portions were not. In this manner I hope that when some patient is injured as a result of something I did not know about their health, that the deep pocket hospital will have been identified as the preventor of information services. The paper (electronic mostly now) trail of memos to administration will hopefully cook someone’s goose like many of the damning memos that appear on new shows.

I try to pick my battles wisely, putting the brakes on the production pressure to keep the ORs moving when it appears possible that critical information exists, but is unavailable to me so that I can insist on various units creating a paper chart of each electronic fragment. Eventually, however, my best judgement will fail me and some critical bit will go undiscovered until too late.

On a slightly different woe, JCAHO has mandated that we can no longer record on our preanesthesia assessment documentation or anesthesia intraoperative record the patient’s allergies. Allergies can be documented only in one place within the record, ostensibly to avoid the occasional occurrance of two sources occasionally being in disagreement. This move is totally boneheaded, as the act of me writing the allergy onto my record is important to imprinting this information into my brain. JCAHOs specific prohibition from me writing allergies onto my chart is inviting an inevitable human slip when the shit hits the fan in the OR

I think that there are two views points to be considered when strongly advocating the use of EMR in practices. For a Doctor it needs to easy to use and save time so that more time can be spend on the patient. Currently we have many vendors with different types of EMR that are so hard to use that it simply puts them off. I think healthcare technology companies need to develop product after regular interaction with doctors to ensure that they provide just what is required. At binaryspectrum we have developed our healthcare solutions after spending countless number of hours with doctors to ensure that its work flow is kept simple and intuitive. This is then followed up with a period of Beta testing in real time environment before it is offered as a product in the market.