By HANS DUVEFELT
This may surprise people with a business degree:
Doctors don’t really care when a test is ordered. We care about our patient’s chest x-ray or potassium level at the same time the test was taken. We also don’t care (unless we’re doing a forensic examination of processing delays) when an outside piece of information has been scanned into the file. We want to know on which day the potassium was low: before or after starting potassium replacement, for example.
In a patient’s medical record, we have a fundamental need to know the order of things. We don’t prefer to see all office visits in one file, all prescriptions in another, and all phone calls in a third. But that seems to be the way people with an accounting mindset prefer to see the world. In some cases, we might need this type of information, but under normal clinical circumstances, the order in which things have happened is how our brains approach diagnostic dilemmas.
The lives of patients are at stake, and to do our jobs we need the right information at the right time, in the order we need it, even if accountants prefer it otherwise.
We are the clinicians. When non-clinicians design our “workflows” things can work like the Boeing 737 MAXX. Engineers thought their new autopilot was great, but it didn’t make sense to pilots. Planes crashed and people died. Boeing initially tried to blame the pilots. Healthcare systems always blame providers when the systems we work with don’t work for us.
What percentage of medical errors occur because we can’t quickly find the information we need – or, worse, because our systems are so clunky that we don’t have time to enter it according to workflows prescribed? Statistics may not reveal the true magnitude, just as the Boeing disaster was not immediately attributed to autopilot. Many medical incidents are likely attributed to human error rather than to the EMR.
We deserve better and our patients deserve better. People around me think I don’t like technology. This is not true. I just don’t have any patience for technology that doesn’t work. If online banking worked like my DME (Hi, Greenway!), The banking system would collapse. Facebook, TikTok, Amazon, Google, WordPress, and my old iPhone SE seem to be doing great. Why can’t EMRs do this?
Hans Duvefelt is a rural family physician born in Sweden in Maine. This article originally appeared on his blog, A Country Doctor Writes, here.