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Re: Computer orders and the electronic medical record From: Dean Huffman (dean@thehuffpeople.net) Tue Mar 5 16:13:25 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Betsy Hyde: "Re: Computer orders" Previous message: R L Meisel: "Re: Computer orders" In reply to: DMECNM@aol.com: "Computer orders" Next in thread: Betsy Hyde: "Re: Computer orders" Until about three months ago (I am at a new hospital), I was one of the strongest advocates there cold be for a paperless computer medical record. Unfortunately, expectations have met with reality and I no longer an such an advocate. Let me give some examples of what happened. 1) On the ward where one is most likely to want to look up old records, there is only one computer available for use in reviewing old records. This computer is responsible for a number of other jobs, too, so doctors, nurses, etc., sometimes have to wait in line to use the computer. This computer also has the smallest screen of any of the computers on the ward. If a full page of text is displayed on the screen, the text is so small that one has to enlarge the page. When this is done, only half of the page can be seen. Then when reading page 1, if one scrolls to the bottom (in order to read everything), then when one goes to page 2, the bottom (rather than the top) of the page appears. The computer screen is landscape (greater width than height) whereas paper documents are generally portrait (greater height than width). 2) The hospital uses Windows95, a very unreliable operating system. It frequently crashes, therefore wasting valuable time waiting for it to reboot. The computer medical record server is also down frequently. 3) Under the best of circumstances, it takes over two minutes for the program to load on a ward computer. Transmission of the document images form server to ward is very slow, too. 4) An updated version of the system was recently implemented. Unfortunately it was not pre-installed, however. Hence, on two different computers, I had to wait for the new system to install when running it for the first time. Twenty minutes wasted, twice. (OK, I admit that I did other things while waiting, but it was over twenty minutes before the program had completed installation an was ready for use. After this happened on antenatal, too, I walked to post partum and got the installation started there so that the next person would not have to wait twenty minutes. Apparently nobody from the computer department had the smarts to make the change at 2:00 AM and then inform the clerks on each ward to start the installation at that time.) 5) It is impossible to print out a copy of a document! That function was left out of the system. Probably intentionally, perhaps in anticipation of HIPPA. There are two workarounds, however. One is to use Print Screen to print the documents, either page for page, in which case the printed copy is almost illegible, or half a page per page, in which case paper is wasted. The other way is to call medical records and have them fax the document to the ward. Interestingly, either of these workarounds probably defeats HIPPA. 6) The computer form of a record is more difficult to use than the paper form. One cannot flip through pages the way one can do with a paper documents. One cannot "take the computer to the bathroom" as one can with paper documents. Paper is just much easier to use -- perhaps the reason it has lasted for so many centuries and why the paperless office has not yet come about. The computer interface is poorly designed. Many minor changes would make the system far easier to use. My conclusion: 1) Computer storage of documents is 1000% better than microfilm. Printed copies of microfilm documents are horrible. Printed copies of scanned documents are almost as good as the original. 2) A completely electronic medical record is a possibility. The one I have seen, however, needs lots and lots of work. As it exists now, it is slow, awkward, and not entirely reliable. It could have been designed far better. It is "nice, but no cigar." 3) The rocket scientists who design these systems must factor in such issues as adequate numbers of computers on the wards, adequate size of computer monitors, reliability of the system (if Windows is used, nothing less than Windows 2000, and preferably a non-Windows operating system), adequate speed of the system under maximum load (including the speed of the work station computer, the speed of the server, and the speed of the communication medium), legibility (i.e., having adequately large monitors, not using "landscape" monitors to display "portrait" documents), producing hard copies when necessary, and general human engineering. It may have been that the physicians revolted and refused to use a good system. It is more likely, however, that the system that was not adequate to the tasks it was being asked to do and the physicians rebelled because of a poorly designed and/or implemented system. I suspect that the system was not "human engineered". In short, it was a poorly designed system that nevertheless "looked good on paper". - - - - At 03:01 PM 3/5/2002 -0600, you wrote: >In a message dated 3/5/02 12:29:50 PM Pacific Standard Time, >dean@thehuffpeople.net writes: > >>My feeling about these computer orders was that either they should be done >>correctly or they should not be done at all. Unfortunatley, that attitude >>was not universal. > >You won't get any argument from me on this one. But I have worked in a >facility where EVERYTHING was supposed to be done by computer. Charting, >orders, progress notes, H&Ps, etc. The hospital was trying to eliminate >the huge paper flow. Some of the docs absolutely REFUSED to >comply. REFUSED to take the computer class. They would actively seek out >old chart forms to write progress notes, orders, etc. Nurses would be >responsible to look in the computer for orders as well as the >"chart." Orders were missed. For patients who were long term, progress >notes were out of order and disorganized. Nurses who missed orders where >reprimanded and some were fired. And the docs, well they won. The >hospital went back to total paper charting. What an incredible >waste. The computers sat idle and only used to look up lab results. > >Denise, CNM >So Cal Next message: Betsy Hyde: "Re: Computer orders" Previous message: R L Meisel: "Re: Computer orders" In reply to: DMECNM@aol.com: "Computer orders" Next in thread: Betsy Hyde: "Re: Computer orders"

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