Category: Electronic Medical Records

Badgering Your Consultants to Death

This article describes a fascinating and absolutely untenable situation with numbers that just defy comprehension.

At an academic teaching hospital in Korea, 75% required consultation towards their admission rate of 36% – and their ED LOS median was seven hours.  Then, they implemented this brutal system in which an automated computer protocol paged out a consultation – and then, at the three hour mark – if there was still no disposition, they autopaged every resident in the consulted department.  Then, at the six hour mark, a page went out to every resident and faculty member in the consulted department regarding the disposition delay.  And their median ED LOS and time to disposition basically each improved by an hour and a half with this intervention.

So, this situation is insane.  Their admission rate is pretty high, but I still cannot fathom consulting on 75% of my patients.  And, these time to disposition numbers are equally alien, especially to a community emergency physician.  At my hospital, if a consultation goes over one hour in our EDIS, the badgering begins – but it’s more likely friendly, desperate begging as opposed to this hospital’s automated irritant spam.

So, shed a tear for Korea and their dysfunctional ED.

http://www.ncbi.nlm.nih.gov/pubmed/21496143

News Flash – Better Electronic Medical Records Are Better

In this article, providers are asked to complete a simulated task in their standard EMR – which is Mayo’s LastWord supplemented by Chart+ – vs a “novel” EMR redesigned specifically for a critical care environment with reduced cognitive load and increased visibility for frequently utilized elements and data.  In their bleeding patient scenario, their novel EMR was faster and resulted in fewer errors.  So, thusly, a better EMR design is better.

While it seems intuitively obvious – you still need studies to back up your justification for interface design in electronic medical records.  Their approach in testing is one I’d like to see expanded – and perhaps even implemented as a regulatory standard – evaluation on cognitive load and a certain level of task-based completion testing with error rates at a certain level.  Electronic medical records should be treated like medical devices/medications/equipment that should be rigorously failure tested.  While EMRs are far more complicated instruments, studies such as this one, illustrate that an EMR with interfaces designed for specific work environments to aid in effective and efficient task-completion save time and reduce errors.

The main issue I see with EMR these days is that the stakeholders and motivators behind this initial wave of implementation in financial – systems in place to capture every last level of service provided to a patient in order to increase revenues.  Now, the next generation and movement with EMRs is to look at how they can increase patient safety, particularly in light of threats of non-payment for preventable medical errors.  Again, financial motivation, but at least this financial motivation is going to motivate progress and maturation of medical records as tools to protect patients, not simply to milk them for profits.

http://www.ncbi.nlm.nih.gov/pubmed/21478739