This blog is totally independent and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Friday, May 01, 2015
This Is A Rather Salutary Tale Of How A EHRs/Practice Systems Can Be Misused For The Worse.
For all their promise, electronic health records sometimes suffer from design flaws that can lead to processes that are just plain nonsensical.
I’m a self-proclaimed health IT enthusiast. I applaud providers who ditch paper and embrace tablets. I always pick the portal over the telephone to schedule my appointments. I get a little giddy when I’m able to walk out of my doctor’s office, head to the pharmacy, and find my meds ready for pick-up, thanks to the miracle of e-prescribing.
But as much as I love health IT, I realize that our not-so-perfect systems have the potential to create some absurd workflows. Case in point: I recently I made a trip to the emergency room as patient. Despite my physical discomfort (all is well now), I did my typical perusal of all things health IT-related there, and paid particular attention to how the staff was using the EHR.
I noted that no one was documenting at the point-of-care; everyone not providing direct patient care was staring at a computer monitor. Staff jotted new notes either onto a paper copy of my (two) previous ER visits or on a paper intake form.
It was the intake form that particularly intrigued me because the staff seemed very set on following it precisely. Part of the conversation with my nurse went something like this:
Nurse: "Do you drink alcohol?"
Nurse: "Do you drink once a day, socially, or more than three drinks a day?"
Me: "Once a day and socially."
Nurse: "No, no, no. You can only have one answer. It has to be either once a day or socially."
Really? The intake form – which was obviously based on the EHR’s format – apparently required users to provide a single, discrete answer for each question. Because of the EHR’s design, the staff was apparently unable to accurately record my practice of drinking a glass of wine a night and partaking in more than one serving while in a social setting.
Once I fully recovered from my ER visit, I got to thinking about other ways that EHR design and workflow are creating processes that don’t always make sense. I recalled a series of visits I had with my daughter when she was experiencing some foot pain. I took her to an orthopedic surgeon, who diagnosed her with plantar fasciitis. During the initial visit the medical assistant took her blood pressure, which seemed reasonable given that the doctor had never seen her before and wanted to ensure her general health was normal.
However, I did find it a little over the top when her blood pressure was taken for each of the two follow-up visits. After all, her case was pretty straightforward: she visited the doctor because her foot hurt; after a little physical therapy and KT tape she was back to normal. I understand that the blood pressure check was incorporated into the workflow to allow the practice to justify a higher level of billing, but does it make it any more logical?