Sunday, August 26, 2012

An Electronic Health Record misAdventure

We thought we were ready. We had all our training. The staff was pumped. The doctors were apprehensive but willing. Tuesday morning "GO LIVE" began. Fortunately the hardware folks just happened to be in the office installing our dual monitors, so there were two techs present when none of our medical assistants (MAs) could access their tablets. Uh oh...

Shortly into the day our office manager discovered that the stand-alone electronic prescribing software we'd been using for years had been turned off since Friday and prescriptions sent electronically since then had never made it to their destinations. Patients were calling. They weren't happy. And we had no way of knowing who they were because our workflow is to fill the prescriptions, document in the chart and file. Uh oh...

Meanwhile, my MA was still unable to use her laptop to triage my first patient. I was waiting...Dr. K had seen a patient, documented most of her note but she could not put in the plan for some reason. This was a problem that went on all day until it was determined that her 'profile' was corrupted. IT promised a fix by the next day. Uh oh...

Remember being told to "save, save, save"? Dr. I, not big on computers to start with, was humming along only to find out that one of her electronic notes, on a complicated patient, had vanished into the ether due to a Citrix glitch, never to be found again. She was nearly in tears. Uh oh...

Finally, my MA had a patient ready for me to see. Only an hour behind. It was a young man, a new patient in for what the scheduling staff was told was an uncomplicated physical. I remember being told that this patient was perfect for the first day on EHR "He's young and healthy, a great start to using the Health Maintenance Template". Except that he was drinking a pint of bourbon daily with a blood pressure through the roof, a urination issue, chest pain and was anxiously depressed. Uh oh...

It is very difficult to have one's attention divided by electronics when it needs to be concentrating on a real person's medical issues. If I had to grade myself with how well that first patient was treated by me, it would be close to failing. It felt like a return to medical school--working blind, feeling incompetent, trying to speak two different languages at once (electronic and paper) and never quite sure anything was being done well.

Rumor has it our skills will improve over the next year. My hope, as one of the first primary care offices to go live in our organization, the technical support staff and the doctors can help other offices begin this journey with a refined send off.

This is a hospital "go live" but still hilariously hit close to home:


  1. If patient(s) were harmed as a result of this chaos...and it is inarguable that harm could have resulted, or still might as of today...who would be liable?

    Note: does the hospital have a "hold harmless" agreement with the seller?

    See "Health Care Information Technology Vendors' “Hold Harmless” Clause: Implications for Patients and Clinicians, Ross Koppel, PhD; David Kreda, BA. JAMA. 2009;301(12):1276-1278.

  2. How are you adjusting to the EMR now, Kathy? EMR’s are intended to lessen the errors in medical health recording, thereby speeding up the medical process. Sadly, the learning curve of the EMR is quite steep, which can cause a lot of stress to the whole medical team. Then, there’s the problem of glitches and other technical failure. Still, I believe this is a great advancement in the field. Medical professionals will find that learning this is an invaluable skill.

    1. Thanks, Edwina. Things are much better but still slower than paper. Now I have the dubious distinction of being the Physician Champion in my market area. So I assume I'll be getting even better. :)