The Email I Want to Send To Our Tech Guys But Keep...

The Email I Want to Send To Our Tech Guys But Keep Deleting…

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Dear Tech Guys:

So today I’m doing anesthesia for colonoscopies and upper GI scopes. Nowadays we have three board-certified anesthesiologists doing anesthesia for GI procedures every single day at my institution. I’ll probably do 8 cases today. I will sign into a computer or electronically sign something 32 times. I have to type my user name and password into 3 different systems 24 times. I’m doing essentially the same thing with each case, but each case has to have the same information entered separately. I have to do these things, but my department also pays four full-time masters-level trained nurses to enter patient information and medical histories into the computer system, sometimes transcribed from a different computer system. Ironically, I will also generate about 50 pages of paper, since the computer record has to be printed out. Twice.

No wonder almost everyone I know hates electronic medical records! I don’t know anything about computers, and I don’t know what systems other hospitals have. I may be dreaming of a world that doesn’t exist or that world is here and I haven’t heard about it. Nevertheless, here’s my wish list for a system that doctors would actually want to use:

1. Eliminate the User Names and Passords: You can’t tell me that in this day of retinal scans and hand-held computers that there isn’t a better way to secure data. What if each person had their own iPad that you only have to sign into ONCE a day that automatically signs your charts. If you’re worried about people leaving them sitting around use a retinal scan or fingerprint instant recognition system.

2. Eliminate the Paper: If you’re going to have full-time people entering data for you, why print it out? It’s on the computer for anyone to access.

3. All Data Systems Must Be Compatible: You can’t have patient data entered in one place that doesn’t automatically import into another place. If my anesthesia record can’t talk to the hospital OMR, I have to RE-TYPE everything in, which is completely ridiculous.

4. Everybody Has to Use the Same System: Everybody, state-wide. Right now, electronic records from a nearby hospital are not available at my hospital, even though the two hospitals are right across the street from each other.

5. Don’t Make Me Turn the Page All the important information about a patient should be on the first page you open when you look up a patient. I shouldn’t have to click six different tabs. Specific to anesthesia, all the relevant data about the patient including what medications they have received during the case should be automatically displayed on the screen when you start a case. Specific to primary care, all the latest labs and data, recent appointments with specialists, current med list and anything else the doctor wants to see commonly should be right on the first screen.

6. Don’t Make Me Have to Repeat Myself. If I do eight cases the same way, with the same documentation required for each case, I still have to enter that documentation each time. If I’m seeing 20 patients in primary care clinic and the rules require the same documentation for each person, I shouldn’t have to enter that documentation each time.

7. Invest in Development of Really Good Voice Recognition Software: If I’m sitting across from a patient, I want to look at them and talk to them, not talk to them and look at a computer screen. If my mother didn’t make me take typing in high school, I don’t want to have to spend 3 hours after-hours every evening pecking my conversations with my patients into a computer, or worse, checking boxes electronically.

8. Get Rid of the Wires: In this day of wireless, why am I still tripping over monitoring wires and untangling cords? My spin bike at the gym can pick up my heart rate without a wire. Why can’t my anesthesia monitor?

9. If You Need a Typist, Hire a Typist: Every time a new rule or documentation requirement pops up, which in my institution is daily, it is always laid on the nurses to add that to their computer records. Nurses used to be nurses. Now they are data-entry specialists. Their checklist and pre-operative paperwork is longer than mine. And they aren’t doing any diagnosis or treatment.

10. Triple Back Up the System: Computers crash. Paper doesn’t. There’s got to be a way to make the system rock-solid reliable.

Shirie Leng, MD is a practicing anesthesiologist at Beth Israel Deaconess Medical Center in Boston. She blogs regularly at medicine for real, where this post originally appeared.

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144 Comments on "The Email I Want to Send To Our Tech Guys But Keep Deleting…"


Guest
Apr 24, 2013

Sounds like a pain, I hope your wishes are granted someday soon!

Guest
Apr 24, 2013

Imagine, if you will, being a patient or caregiver with a number of clinicians in different facilities, using different systems, and you’ll know that your pain isn’t felt only on the clinical side.

For patients, data contained in our EMR could spell the difference between life and death. What if it’s wrong? And so much of it is wrong, particularly on the med-rec side. We can hardly see it. We cannot in any easy way fix it ourselves.

For all the promise that EMR tech holds, we’re seeing none of it delivered in the US. $9B is buying us shiny new silos to replace the dusty paper silos, but any meaningful use-fulness is almost accidental.

How about patients AND clinicians band together, and storm the HIT castle? The glacial pace of usefulness development has to accelerate, or we’re all boned …

Member
Apr 24, 2013

Money quote #1:

“Don’t Make Me Turn the Page All the important information about a patient should be on the first page you open when you look up a patient. I shouldn’t have to click six different tabs.”

Money quote #2

“If You Need a Typist, Hire a Typist: Every time a new rule or documentation requirement pops up, which in my institution is daily, it is always laid on the nurses to add that to their computer records. Nurses used to be nurses. Now they are data-entry specialists. Their checklist and pre-operative paperwork is longer than mine. And they aren’t doing any diagnosis or treatment.”

Guest
Apr 24, 2013

It’s so great that you posted this. I think user responses are so important, and companies that don’t listen to them are doomed to failure. I can understand though why you don’t send it to your IT guys. Do they have that much control over these things?

Guest
Apr 24, 2013

I’ve talked to them. They are handcuffed by HIPAA and other regulatory agencies and security guidelines.

Guest
Apr 25, 2013

I don’t totally agree. IT is hamstrung by their funding, mindset, and past experiences. Many are averse to change and unable to adjust their perspective from the system to the user. Some companies, including mine, have developed EMR software that adjusts to the needs of the users instead of forcing the user to adjust to the needs of the software. This model exists but is not yet prevalent.

Don’t let them hide behind HIPAA. That is a smokescreen.

Guest
NL
Jun 13, 2013

Preach! Love your list!

We need more people who actually input data and work with the patients designing these programs- shout out to Nursing Informatics

Guest
Fan of HIS Talk
Apr 24, 2013

First question I have is whether the current best evidence suggests that anesthesia should be given routinely for colonoscopies?

Maybe what you guys need is clinical descision support.

Guest
Apr 24, 2013

Oh yes, don’t get me going on THAT subject! I completely agree with you. The ones I do are supposedly “difficult”, ie, old, sick, or more often, fat. As long as insurance pays for us, our department heads will keep staffing GI.

Guest
Apr 24, 2013

Little makes me crazier than the arrogance of tech guys (other than maybe the malpractice and health insurance systems :).

The whole idea that we, the doctors, are out of date, unwilling to change, and locked in our anachronistic ideas and workflows are the reason why EMR systems aren’t being utilized effectively is ridiculous.

I have experienced every single one of the issues you describe and it is insane making. There are so many true clinical decisions I am running each day, getting locked in documentation and data processing details often just distracts me from the truly important work and from connecting with my patients. Add volume pressures, concerns about accurate documentation for both reimbursement and legal reasons, and the upcoming importance of documentation from a quality correlation, and the system becomes overwhelming.

With EMR systems being mandated by the ACA and a few large vendors dominating the space, there is surprisingly little incentive for them to listen to their customers and end users and make the changes that we want. Maybe we should just call Vinod Khosla and have him take over for our technologically incompetent selves now.

Guest
Apr 25, 2013

Large vendors = slow to change and last century thinking. The risk is actually higher to stick with the dinosaur technology than to investigate the up and coming businesses that might offer innovation but haven’t yet earned the 10 year track record. Smaller = more flexibility, stronger customer focus, and desire to make it work.

Guest
Apr 24, 2013

@Fan of HIS –

If you think there should be no anesthesia used for colonoscopies, I will recommend you to a few colleagues of mine who would be happy to clean our your colon and stick a giant tube and camera up your *** without any sedation. I’ll let you run the ‘clinical decision support systems’ and I’ll just take IV meds.

Guest
Apr 24, 2013

m13 – thanks for reading. Colonoscopies are never done without sedation. Nurses can provide perfectly adequate intravenous sedation for this procedure. What Fan of HIS is talking about is sedation done by anesthesiologists, a much more expensive proposition and usually not necessary.

Guest
Bonnie Larner
Apr 24, 2013

Empathize with your frustrations, and I am a patient! I have two docs on the same floor in a medical facility who cannot share my records!

Guest
Apr 24, 2013

You’re just a Luddite technophobe, Dr. Leng.

Don’t you know that meaningful use of EHRs automatically and dramatically improves the quality of care, saves billions of dollars, allows medical errors to be eliminated (even, say, perforations during your procedures, as the Lords of Kobol are overlooking you with EHRs), and rejuvenates the patient by at least ten years?

What’s the matter with you, anyway?

See my blog writing at http://hcrenewal.blogspot.com for more on the miraculous benefits of EHRs…and stop being such a whistleblower.

— InformaticsMD

Guest
Apr 24, 2013

HAA! Read your latest post. Good stuff.

Guest
Apr 24, 2013

Does it make me skinnier too?

Guest
legacyflyer
Apr 24, 2013

Good practical observations.

Do IT people know what “user friendly” means?

Guest
A man who knows
Apr 24, 2013

In response to your under clarity and lack of an IT perspective my dear physician, followed with a response to the “arrogant IT people”. Pot please meet kettle!! You speak of IT as arrogant, but perhaps the answer of “no or it cannot be done” isn’t arrogance at all. See you practice medicine, as you state above. Your phd didnt encompass interfacing, workflow, networking, software and security. Our two worlds have collided, that is a fact. You would scoff at the idea of an IT person treating your patient because they aren’t trained to do so, yet feel the need to belittle or undermind the very services they provide. Perhaps you should give these very same people the ability to critique your work, second guess your decisions, call to light your misdiagnosis’s, you know the ones these very people fix before the judicial system has requested. I presume your IT personal are working within the confines of what is allowed and how the softwares are designed to function. Maybe using their expertise to have continual discussions with your vendors will allow you to refocus on your expertise.

Guest
BobbyG
Apr 24, 2013

“undermind”?

:)

Guest
Dr. Mike
Apr 24, 2013

You sound like one of the tech guys as in the guys or gals in IT. Not sure what that has to do with the tech guys as in the guys or gals who code software. Sure you may have taken lots of code classes and might occasionally even use what you learned to write a batch file or interface, etc., but I doubt you had anything at all to do with the POS software the poor doc is forced to endure. So in other words your hackles are up for nothing.

Guest
Apr 25, 2013

Wow. I never called IT people arrogant and never would. Absolutely our IT guys are working under the constraints of the systems the hospital bought, regulatory factors, and security concerns. I’m really addressing my complaints to the broader EMR community at the coding and development level.

Guest
Apr 25, 2013

I am an IT person and can still cite examples where the corporate IT organization was equipped to do a simple thing to make the care provider’s job easier, yet refused to do so because they did not understand the request. I know IT is difficult and most large IT shops are understaffed and overwhelmed. What I don’t get is the lack of understanding that the sole reason their job exists is to enable the care team to function more efficiently. Patients do not visit a hospital to meet the IT guy. They visit a hospital for care from the providers. If IT is not empowered to deploy solutions that enable the functionality listed above, senior leadership needs to change. If IT is empowered, yet chooses not to, they need to be replaced.

My company has designed an EMR that addresses most of these issues, but we are often excluded because IT won’t investigate our solutions. The fear of purchasing from a smaller company that can provide innovation, support, and flexibility is greater than the pain they inflict on their providers by deploying archaic systems.

Guest
Apr 28, 2013

It should be remembered:

The role of health IT personnel and physicians is anything but symmetric. IT personnel have no clinical obligations or liabilities. They are facilitators of healthcare, and their role would not exist without physicians and other clinicians, who up to now have been solely liable for outcomes. The opposite is not true – physicians don’t need IT to treat patients.

However, since some IT personnel seem to act as if they have similar obligations and liabilities as physicians and other clinicians, I am recommending to the Plaintiff’s attorneys I educate on HIT-related medical error that the IT guys be deposed and, where appropriate, named as defendants.

Welcome to the clinicians’ world.

Guest
Jeff Goldsmith
Apr 25, 2013

Right Fricking On, Dr. Leng! Send this email, not to your Tech guys, who are drowning, but to the CEO’s of the software firms that designed your stuff in the first place. Maybe they could get you on the program at the next HIMSS conference, the IT vendorfest where all this stuff is sold.

Priceless feedback from a frustrated user. You speak for millions.

Guest
Apr 25, 2013

HIPPA is the problem here. Yes the 600 million dollar implementations are a result of government regulation. The new requirements are coming out faster than IT can typically keep up. With people still tweaking 5010, ICD10, down the pipeline, and keeping up with meaningful use, I think everyone is feeling the squeeze here

Guest
BobbyG
Apr 25, 2013

HIPAA is a problem as well.

Guest
Apr 25, 2013

Great points. I think, at least on the information governance and sharing side, the answer will be found by putting patients in control of their records through a patient-controlled medical record, rather than trying to kluge together interoperability in HIEs that aren’t really working.

Guest
Apr 25, 2013

As an RN, let me say THANK YOU for mentioning point #9: “Every time a new rule or documentation requirement pops up … it is always laid on the nurses to add that to their computer records.”

and

“Nurses used to be nurses. Now they are data-entry specialists.”

5 or 10 years ago, my charting to document my patient’s assessment (Med/Surg floor) covered 1 computer screen. Now, it is dozens of screens. Yes, DOZENS. I have to document not just things one would expect like heart sounds, lung sounds, etc, but also items such as:
-That alarms on all machines connected to the patient are audible
-That all spiritual and psychosocial needs were addressed
-That I have done teaching about drug resistant organisms
-The patient’s risk of falling (5 computer screens for that item alone)
-Nutrition risk
-Skin breakdown risk

…and on and on.

The burdensome documentation was one reason that I decided to retire early.

Sad .. I absolutely LOVE being a nurse. But not being a data entry specialist.

Guest
legacyflyer
Apr 26, 2013

Brenda,

You have hit the nail on the head! You are not serving the patient when you fill out all those forms, you are serving the malpractice attorneys and the payors .

Filling out all of this nonsense “paperwork”/electronic forms, takes time away from seeing the patient, listening to the patient, examining the patient, etc. – the important part of being a nurse.

Anecdote – my dad died about a year ago and for the last year of so of his life he was “on hospice” because of a Klatskin tumor. He actually did so well for a while that he got kicked out of hospice. What being “on hospice” consisted of – for him – was having an excellent nurse come around once a week, give him a good bath, give him a good shave and baby him a little. He really liked her and what she did was worth a lot to him. And of course they talked together about a variety of things. They bonded – when I would go see him he would tell me about her and her life.

While this was going on the RN’s at my Dad’s “assisted living center” were generally busy writing in charts, filling out papers, etc. This is backwards! The RNs should be seeing the patients and the nonsense paper work should either be eliminated or given to clerks.

Documentation (forced on us by lawyers and insurance companies) is the enemy of good interpersonal care. The kind my Dad so appreciated.

She wasn’t an RN, she was an LPN or some other type of lower level provider.

Guest
legacyflyer
Apr 26, 2013

Oops,

Last sentence out of order. Should be after 3rd paragraph