My Saturday morning walking partner asked me yesterday, "So when do you get to quit being an IT professional and go back to being a doctor?" Wow, good question.
In the not quite three weeks of this new form of documentation I have been consumed with trying to understand and make the EHR work for me. No longer do I have to consult a "superuser" every ten minutes with questions but every day I'm trying to figure out the most efficient way to care for people using this frustrating new tool. The "muscle memory" is beginning to kick in thank goodness, so time per patient is less. Now my frustrations are more with what seems to be a very inefficient system. I struggle to determine whether I am the problem or the EHR is. Most likely it's a little of both. The term Mission Hostile User Experience coined by Scot Silverstein comes to mind. What is scary here is the potential for patient harm - between my distractibility due to the steep learning curve of the Allscripts system, the fact that no one has told us how to clean these "Toughbook" fomites that we carry from one patient exam room to the next, and the patient care error potential inherent in the software itself, these are the ever present worries that keeps me up at night.
On Thursday of this week, the EHR Steering Committee for my organization will meet and I will have the opportunity to present the go-live experience and make suggestions for improvement as other offices in the system go live. Throughout this process there has remained a sense of re-inventing the wheel, which seems odd considering that Allscripts EHR has been in existence for years, having gone public in 1999.
At any rate this blog is obsessed with EHR right now--but the essential question remains. When do I get to go back to taking care of patients?
For more on these issues, see "Contemporary Issues in Medical Informatics: Good IT, Bad IT, and Common Examples of Healthcare Information Technology Difficulties" as well as numerous posts on health IT dating to 2004 on the multi-author Healthcare Renewal blog.
ReplyDeleteMy organization had to sue this vendor to get an E&M billing module that even worked.
ReplyDeletehttp://hcrenewal.blogspot.com/2007/10/medical-informatics-still-round-peg-in.html
Here is a link to civil complaint in PDF.
I observed similar problems with a different vendor...at Yale-New Haven Hospital...in the early 1990s - see here - that resulted in a Justice Dept. investigation, huge fines, and expensive IT scrapping and replacement.
The industry does not learn.