By HANS DUVEFELT
This may come as a surprise for people with business degrees:
Doctors don’t really care when a test was ordered. We care about our patient’s chest X-ray or potassium level the very moment the test was performed. We also don’t care (unless we are doing a forensic review of treatment delays) when an outside piece of information was scanned into the chart. We want to know on which day the potassium was low: Before or after we started the potassium replacement, for example.
In a patient’s medical record, we have a fundamental need to know in what order things happened. We don’t prefer to see all office visits in one file, all prescriptions in another and all phone calls in a third. But that seems to be how people with a bookkeeping mindset prefer to view the world. In some instances we might need that type of information, but under normal clinical circumstances the order in which things happened is the way our brains approach diagnostic dilemmas.
Yes, I have said all this before, but it deserves to be said again. Besides, only 125 people read what I wrote about this six weeks ago, while almost 10,000 people read my post about doxepin.
Patients’ lives are at stake and, in order to do our job, we need the right information at the right time, in the order we need it, even if the bookkeepers prefer it a different way.
We are the clinicians. When non-clinicians design our “workflows”, things can work out just like the Boeing 737 MAXX. The engineers thought their new autopilot was brilliant, but it made no sense to pilots. Planes crashed and people died. Boeing at first tried to blame the pilots. Healthcare systems are still blaming providers when the systems we work with don’t work for us.
What percentage of medical errors occurs because we can’t quickly find the information we need – or, worse, because our systems are so clumsy that we don’t have time to enter it according to the prescribed workflows? The statistics may not reveal the true magnitude, just as the Boeing disaster was not immediately attributed to the autopilot. Many medical mishaps are probably blamed on human error instead of the EMR.
We deserve better and our patients deserve better. People around me think I don’t like technology. That’s not true. I just have no patience for technology that doesn’t work. If online banking worked like my EMR (Hi, Greenway!), the banking system would collapse. Facebook, TikTok, Amazon, Google, WordPress and my old iPhone SE seem to work just fine. Why can’t EMRs?
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.
