Embrace & Interface: Healthcare Information Technology

Let’s talk about the electronic medical record (EMR). There is no halfway with this modern medical tool. Like bathing your private parts in an icy pond, EMR requires that you jump in with both feet.

Of course, you might claim to be a Neo-Luddite. The Luddites in England of the early 19th century disapproved of the industrial revolution and sabotaged factories to protest the replacement of their skilled labor jobs by machinery. Their attempted social de-evolution resulted in execution or transportation to Australia. Many today, wishing for return to a quieter, calmer, slower existence, believe that the Luddites may have been on to something.

If you lean toward the neo-Luddite, you might elect to avoid EMR like the plague (In fact, you won’t find much dispute in medicine that the plague is in fact a good thing to avoid, so perhaps the analogy is not a great one). We all know people who don’t have an e-mail address, which in our era is like not being sure how to use a telephone or play a CD. But I’m not always certain how to use the multifunctional cell phone that I own ... Oh my gosh, perhaps I’m a neo-Luddite too!

My brother Robert is what I call a selective Luddite. Although he works as a high-level computer programmer, he carries a pocket watch, and doesn’t even own a cell phone. He is confused by conversations about joining your ‘circle’ as he limits his television viewing as well. Given the frequent interruptions of my life by my own personal torment device — also known as a cell phone — I can see his valid Ludditian point.

Regardless of my status as a neo-Luddite wannabe, I am an EMR cheerleader. I designed my own one-person practice to be enhanced by use of new EMR technology — a technology that allows the practice to more easily serve our patients. When a patient calls, we all may have access to his or her chart at the touch of a button. Immediate, real-time care can be given. In addition to better customer service and better patient care, our practice costs a lot less — less transcription, less chart-pulling by staff, and less postage, since most correspondence is sent out by fax.

Referring physicians like our faxed reports because their speedy results while a patient waits in their office are near-instantaneous...and they only request records in the rare instance that records are not faxed out on the very day that the patient is seen.

Beyond the office management and customer service logistics, we enjoy lifestyle logistics. I can check my lab results and write notes where I am right now, sitting on my back porch with a wireless connection. My staff can sign on from home to provide clinical support. My nurse Deb often takes patient information sheets home to do data entry in the evening or late at night for our direct-access colonoscopy patients; she can access the office via secured server and a virtual desktop. I myself have kept in touch from the Incan temples of Peru and from my rural lakeside retreat.

My EMR buys my staff time and flexibility. My freedom comes in a bundle that weighs less than five pounds.

But what about endoscopy? Is the power of EMR being harnessed wisely in your suite? Perhaps not.

From the doctor’s point of view, EMR is groovy. We use software like EndoSoft, allowing us to quickly generate a report with full-color photos based on personalized templates, and then send that report by fax to our referring docs and hand a spare copy to patients. Quick gratification. Great customer service. Exclude the middleman/woman of medical records and transcription. What’s not to love? Our hospital loves our endo EMR too, estimating that we might be saving as much as $100,000 per year in transcription costs (of course, the system costs money, but once it’s up and running, the payback period is relatively short).

But then I look at my circulating nurse’s work station and roll my eyes. In my humble opinion, endoscopy nurses and EMRs have not properly interfaced. Anna’s cart features a computer screen and keyboard for the surgical scheduling computer, another computer screen for the hospital system (to enter pathology history data), and yet another screen for the monitor, the vital signs displayed then entered manually into papers wedged on the remaining sliver of space on the desk. Adding another non-interfacing computer does not constitute a useful patient care tool; the problem in our suite seems to be a commitment by the hospital information systems (HIS) folks to make the interface of these multiple machines work.

My question: Do your nurses, particularly the specialty nurses like those in GI, have a seat at your hospital’s HIS conference table when new technology is chosen and implemented? I cannot imagine it is so, with the lack of coherence I see on that cart across the stretcher from me each day.

What to do? Have your endoscopy unit manager contact HIS and hospital administration and make sure that interested and tech-savvy nurses are appointed to purchasing and implementation committees for new software installations at your facility. Or appoint a tech-savvy endo nurse to interface with HIS geeks to work on the endo system you already have, until a smooth and seamless interface between the multiple monitors is realized.

EMRs hold a great deal of promise in medicine — the promise to allow us more quality time with our patients, less redundant labor, better communication. But only you can dare to embrace, and interface with, your technology. It’s either that or face transportation as a Luddite.

Pseudo-technogeek Patricia Raymond, MD, FACP, FACG, (www.RxForSanity.com & www.YourHealthChoice.net) is good at turning on computers, and even better at calling technical support and insisting on one-syllable answers.