Unless you have been living under a rock for the last couple of weeks, you have probably been concerned with the Ebola epidemic.
Truly this epidemic is unprecedented and will have profound effects in Africa and around the world if not contained.The recent patient who died in Dallas and the transmission to nurses who was caring for him brings this much closer to home.
How this patient was cared for in his initial Emergency Department visit brings up a major concern that I have with our current infatuation with computerized charts and electronic medical records.
It appears that when Mr. Duncan came to the Presbyterian Hospital in Dallas presenting with a high fever and severe pain, he did inform a nurse that he had traveled from Liberia. And yet the connection was not made that he could be presenting with Ebola, and not sinusitis which he was diagnosed with.
Here’s my concern, did the nurse enter his travel history from Liberia into a computerized medical record, or did she communicate this with the Emergency Department Physician caring for Mr. Duncan? That is to say, did she talk to a computer, or did she talk to a person? Did this information get passed down the line?
Let me hasten to mention that I am not being critical of the team taking care of this patient. However, the outcome of this treatment would seem to have been in error. My concern is with the system, specifically the current reliance of long, cumbersome, non-intuitive medical charting systems. Is it possible that the nurse made a notation that became lost in the computerized medical chart? Very possibly.
The problem with electronic medical records
The influx of electronic medical records, aka EMR’s, has had two serious deleterious effects: health care workers are paying more attention to computers than patients, and the records are so cumbersome as to hide the pertinent data. Let me address the first problem.
A recent experience that I had with my wife having a routine screening procedure can illustrate the point. While she was having an IV started in her arm, a nurse was rattling off health history questions with her eyes glued to a computer screen and facing away from our patient. There was no eye contact, no personal interaction, but the need to complete the computerized record. Again, I am not critical of this nurse. It’s the system that is diverting attention away from the patient and to the computer.
I am reminded of my courses in physical diagnosis in medical school when we were instructed to concentrate on and interact with the patient while taking a history, and not being focused on writing everything down. We all need to be reminded that we are treating a patient and not a computer!
I also noted another issue with EMR’s within a single hospital. This is that the computerized records in one area of the hospital do not necessarily communicate with those in another. Such that having told a pharmacist who is inputting data about allergies in one office, the next nurse down the hall does not have this on her screen. How can this be? Or the fact that the EMR’s in an Emergency department or Operating Room, may not communicate with the EMR’s in the hospital.
How To Protect Yourself From The EMR:
1. Speak Up.
Be prepared to repeat the pertinent aspects of your history and medical condition to the different health care workers you encounter. Could the outcome of the first hospital visit for Mr. Duncan be different if he, or someone with him, had said to the doctor, “I don’t know if the nurse told you, but Eric just come back from Liberia”? He may well have thought that the information he relayed to the nurse was communicated to all, but it may not have been. The information may not have been passed down the line.
2. Bring a Caregiver Who Will Act On Your Behalf.
In addition to talking responsibility to communicate pertinent information to your health care workers, it is also good to have someone there to act as your ombudsman. Someone who can help relay your concerns especially if you are distracted by someone putting an IV in you. Or just that you are distracted because you are nervous, or sick and not at your best.
The truth of the situation is that EMR’s are here to stay. Certainly they have some real advantages, and I am not a curmudgeon who believes that all computers are evil. But on the whole – as I have encountered them – they are not ready for primetime. So the best thing I can say to you, is be careful: make sure that your concerns are communicated, and have someone there to be your wing man.
David B. Reath, MD
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