The EMR is a technology that was supposed to improve clinical medicine (revolutionize it, some say). It was supposed to facilitate clinical medicine. It was not supposed to slow physicians and others down to the point of impairing their ability to practice medicine. However, the rosy predictions are not proving to be the case. Instead, we have the ultimate workaround to the health IT mission hostile user experience: [the medical scribe].
On the HisTALK blog today, apparently one medical center agrees:
By February, all ER physicians at DePaul Health Center (MO) will be using scribes for electronic medical documentation. Administrators hope to improve staff productivity as well as patient satisfaction. Apparently patients were “annoyed” that doctors were sharing their attention with a computer.
In the cited article "Scribes are finding their place in emergency rooms"
"[With a scribe] I can just completely focus on and deal with the patient," [ED physician] Lebo said.
The emergency department at DePaul Health Center in Bridgeton, which sees about 60,000 patients a year, is the first to use scribes in the St. Louis area. By February, all the hospital's emergency physicians will have a scribe tapping away at a laptop or tablet computer while they work. Across the nation, about 200 hospital emergency departments have started using scribes, most within the last two years, according to the three major companies providing scribes.
Several points worthy of note:
- The cost of scribes will be an issue affecting the supposed ROI of EHR's, and are necessitated by the fact that the EHR and its mission hostile nature get in the way of physicians. (See Dr. Doug Perednia's analysis at this link.)
- Scribes are a workaround to the mission hostile user experience.
- You should not have to work around something that is not in the way.
- That a technology touted as of extreme benefit now is seen to need an "isolation layer" between enduser and subject of the system's benefits is another example of how health IT remains an experiment.
-- SS
I've not worked in a private ER where they have scribes. But after more than a decade at the VA (first as an RN, then NP in different roles including inpatient and outpatient care), I can tell you that CPRS definitely has impeded care. A while back I contemplated working extra shifts in the ICU to supplement my income. However I found the Bar Code Medication Administration (BCMA) process so onerous that I decided it was not worth the hassle. Initially the RNs found work arounds to improve the BCMA process, but were caught and reprimanded. BCMA resulted in it taking nearly twice as long to administer meds on a g-med ward. The inventors tout safety, but if the RN is spending hours passing meds, she sure as heck isn't assessing patients or tending to their other medical needs. While the right med is being administered, Mr. Smith down the hall may be desaturating and no one is aware.
ReplyDeleteOver the past 5-6 years the progress notes written by housestaff have evolved to be totally useless. They cut and paste either their notes or someone else's note without changing the assessment or plan from one day to the next. No one seems to care that the daily progress notes regurgitate the same worthless content.
Re: Anonymous January 28, 2011 12:37:00 AM EST
ReplyDeleteIf CPRS is this bad, then the commercial sector by comparison must truly be a cybernetic Alice in Wonderland.
On barcoding, issues there are no surprise. See Koppel's article "Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes and Threats to Patient Safety" that I described in my June 2008 post "Business v. clinical computing: Workarounds to Barcode Medication Administration Systems ".
-- SS