Throughout the past two years, I have rotated mainly through one system. To my dismay, it had been one of the worst as far as electronic health records (EHR) are concerned. Most days I observed the workflow, thinking “If they just did this, they would cut the duration of morning rounds in half.” Let us look past the point that I was usually bored out of my mind!
There was just so much wasted time in dealing with documentation and communication. We are in the digital age. It really shouldn’t be this complicated. I cannot imagine how frustrated the residents and attending physicians must have gotten during this nonsense. This part of the job, which is non-medical, has likely been the direct cause of many doctors’ burnout statuses.
Since I have limited exposure to other systems, I am curious to know if this was a well-below average situation or a fairly normal one (feel free to comment below).
Here are a couple of the terrible operational activities I’d witnessed during my time:
1. The hospital had a hybrid system stuck in the transition from paper to digital
The hospital had an electronic record that was used for orders, labs, and diagnostic tests. That seemed reasonable. In order to view any of the radiology, one would have to open the PACS application, which was integrated into the EHR. Again, this was not an inconvenience.
The problems occurred when physicians needed to document a history and physical (H&P) or write progress notes. Initially residents may have hand-written the H&P, then either s/he or the attending physician would dictate the document via phone. Mysteriously (to me anyway), the H&P appeared within the EHR a few hours or a day later. That is great until you are a resident or student on the team that is in charge of the patient’s care the next morning, which may only be hours later. Although sign-out sessions definitely helped, residents were still forced to dig back into the chart to get the whole story.
As for progress notes, which detail the patient’s course in the hospital, all were on paper. I had personally spent up to 45 minutes reading through a chart trying to decipher each progress note. Some residents wrote notes like they were a human type-writer. Unfortunately, most had written as if they were drunk.
This all translated into checking 2 systems for every patient. One can imagine how inefficient this made everyone involved.
2. Consulting physicians many times used hand-written notes to communicate with the primary team
Consultants often used the method described above to dictate a note that will be uploaded into the
EHR. However, the primary team seeing the patient could not wait for the digital document and had to read directly from the paper chart. This is where the nightmare of translation began.
Typically consulting physicians write in a lost language known only to them. I’ve watched residents photocopy a note from a consultant to hand to the senior resident during rounds, simply because the resident could not understand the note at all. Mind you, this was key, vital information that could be extremely pertinent to the patient’s care.
If a resident was in that situation, the next step was to completely disregard the note and page the consultant. Fifteen minutes to two hours later, the primary team would hear back from the consultant, who was irritated because the team didn’t read his note. It was quite a scene, actually.
Overall, this insanely convoluted system absolutely impaired the ability of attending physicians and residents to provide anything above average education. Not to mention, this was the first time I had a hand cramp since high school!
So, is this one of the worst EHR situations in the country or am I just noticing typical inefficiencies?
William Rusnak is a fourth year medical student, financial investor, writer, and entrepreneur. He writes about topics such as healthcare technology, biotechnology, and nutrition. He is currently applying to residencies with plans to practice in Primary Care and Sports Medicine. Outside of his professional life, he is a family man, performing musician, and paleo-diet enthusiast.
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