Dearest electronic medical record,
Thank you for permitting me to read all the notes for my patients, going back for years, if not decades, in a typed, readable font. Thank you for storing all the lab values, also going back for decades, with a clearly available range of normal values for the laboratory that generated those values. Imaging results, from PET scans to chest X-rays, are similarly available at the click of a button. And thanks, also, for helping with billing. I don't really know what you're doing with all that, but I understand the the hospital administrators really like particular feature. It's really hard to underestimate how important these three things have been in improving care in hospital settings.
I just want to encourage you, electronic medical record, going forward, to learn from your mistakes and maybe offer some constructive criticisms.
You're starting to get a little big around the midsection. I call this "Note bloat". Doctors today are very busy, serving more and more complex patients, and often at a fairly high level of specialization. That means its more important than ever that they be able to communicate succinctly. But when I try to use you, sometimes I have to scroll through pages of auto-generated ... I hate to say it ... garbage, before I get to a decently written paragraph written by a human who has seen the patient recently. That paragraph can be located just about anywhere in the text, and is sometimes, bizarrely, not anywhere to be found.
You're also slowing down a bit. Maybe because of the bloat, you have some trouble with load times. Google is great in no small part because it is so damn fast. You go to a simple page that loads quickly, type a search, and get relevant results from the entire internet quickly. Medical records are big, sure, but why on earth does it take orders of magnitude more time to search the medical record than it takes to search the entire internet? Time is money, but it's also user-sanity. I hear that there are methods like indexing which can improve this kind of thing.
On a similar note, you're loosing agility. Record systems like you used to be bespoke amalgamations that individual hospitals and practices assembled from parts scavenged from medium size software companies and their own in-house ingenuity. Today, it's pretty much EPIC. While EPIC is often customized at time of purchase, the resulting software is hard to change.
Here's an example of the above points. I often work in a frozen section lab. We offer rapid tissue diagnoses, mostly telling surgeons whether a specimen they send is cancer vs. not cancer, in 20 minutes or less, while the patient is on the operating table. It's critical that we know which patients are coming in advance, and be able to look up their history. Looking up the histories the night before, I read notes on dozens of patients, often in the realm of about 30-40 or so. I get that list by culling a list of hundreds that are planned for the OR that day. I need to efficiently load each patient's record, find the notes that are relevant to the operation being performed, identify key elements of the imaging history and past medical history, and possibly identify prior operations that may alter the anatomy of the specimen we are going to process. This process can take hours, but of course it is only possible because we have an electronic medical record in the first place.
In the first step, culling a list of hundreds of operations down to those that actually are likely to require a frozen section diagnosis, currently makes use of custom computer programs written in the pathology department. Ideally, these programs could be integrated into a specialized "pathology view" of the OR schedule.
The second step, loading the patient record, requires 5 clicks, each of which can have a slow load time. There is also an issue where the program brings up multiple patient records from what should be a patient unique medical record number. This introduces a possibility of error (it has not, yet, but it shouldn't even be possible). Ideally the entire pre-filtered list of patients in the OR that day could be preloaded with one click, allowing access to each patient quickly and unambiguously.
The third step, reading through the records, requires me to identify important notes for the particular surgery of the day from a half dozen to hundreds of other recent notes. Many doctor's notes aren't that important for my specific purpose, e.g. the patient's physical therapy notes. Others are extremely important, such as the note from the surgeon seeing the patient before the operation. There is no way to generate customized algorithms to search, filter, and sort these notes based on what the operation is, who is doing it, and what sorts of notes we (as pathologists) generally find most useful. Sure, there is a search function, and a filter function, but these are clunky, slow, and very limited in their customization options. Better than nothing, but less than ideal.
The fourth step, actually reading those notes, frequently runs into the problem of note bloat. Thank goodness I don't have to read doctors' individual handwriting, but I do have to scroll through a lot of auto-generated content. That content is often there, sad to say, for the purposes of billing. Sometimes you get to the end of a note and realize that the entire thing is a billing document. This takes minutes, per patient, which adds up to hours over the course of a week. I can never get that time back, and I'm not really learning anything but what font sizes and formats the auto-generated stuff normally uses so I can scroll quicker.
We can do better! It's not even that complicated! Notes are really just formatted text stored in databases. A physician with a little programming know-how could write very simple programs that would save hours per week for doctors in a their specialty. But there is no avenue to perform such customization. Moreover, as the marketplace becomes increasingly dominated by very few corporate providers, if not a single dominant provider, will there be any motivation to improve the product?
Electronic medical record, you have so much potential, yet untapped! I dearly hope that you see it. If not, perhaps you could attend some motivational seminars. Get some help from some computer literate medical colleagues! With a little ingenuity, I think you can shed the weigh, speed up, and improve your agility. It'd be great for your health, ours, and our patients,
Sincerely,
A Faithful User
No comments:
Post a Comment