Comments on: Being John Glaser 11/10/09

By: Long Time RN

Long Time RN — Fri, 13 Nov 2009 12:38:50 +0000

interior designer….thanks for your comment. It really sheds light on who you are because if you were as knowledgeable as your pretentding to be you would go out and search and find the exact articles that you are asking to be published. From my organization I would say that a dozen or so are our there.
Additionally, you keep mentioning mistakes and calling it retardation of medical care. People wake the heck up. Medical Care is medical care. You are the medical profeccional and therefore you deliver the care, your mistakes have nothing to do with a computer. If you order the wrong drug, forget a critical assessment, or are flat out negligent in your practice then you are simple a terrible clinician who pays little attention to his/her job and as a result is a detrement to patient care. the EMR is never connected to the patient. The EMR is never in charge of making a decision regarding a course of treatment. Most computer mistakes like the one’s you mention are ID10T errors. Your hosptial either bought a shitty system which was probably a top down purchase where clinicians were not involved or your professional training predates the use of the compter.
If you hospital installed a crappy system then your problem is not an indrustry problem. Get on a hosptial committee, look up the articles that have been published, which you requested, there are about 2 articles per year on our solutions efficacy in improving patient care so I am sure you can find hundreds of them and stop whining. ASk for a change, look for the vendors who are getting it right and take a stand for patient safety.
The industry term as you so eloquently write “retardation of medical care” is really called “automating your problems”.
It all boils down to one thing. The problems with drug errors, unbillable records, lost records, lab specimen mixups, infections from leaving lines in too long and not giving antibiotics for surgery are the reasons why electronic records were concieved. To remove your human error from the process as much as possible. Adn we should thank you because if you had cared enough to figure out a way to do it properly on paper then you would have been King and we would not exist. Instead you either passed the buck, ignored it, formed a committee of likeminded apathetic people whos end result was to create another peice of paper, a few stickers, and to take a highly trained RN to walk around and double check everyone’s work. We are kind of like giving you step by step directions adn hoping that you will pay attention, listen during training, ask questions when your unsure and take your time to document electronically correctly.
Remember you mistake at the bedside and your mistake at the computer are still your mistake.

By: Programmer

Programmer — Thu, 12 Nov 2009 16:39:08 +0000

The new mistakes facilitated by the “automation” overwhelm the ones that the HIT vendors claim to be correcting

Write it up and get it published in a peer reviewed journal.

By: interior designer

interior designer — Thu, 12 Nov 2009 15:01:24 +0000

“There are IT choices out there that truly return the RN and MD to the bedside and eleminate the administrative duties that are often demended of them and a poor use of resources while helping to improve patient outcomes.”

Write it up and get it published in a peer reviewed journal.

“My point is this, human error accounts for a large percentage of the medical mistakes made, either from illegibility, non standardization of terminology, and a lack of checks and balances. This is what automation in itself can offer when used properly.”

The new mistakes facilitated by the “automation” overwhelm the ones that the HIT vendors claim to be correcting. Automation is the incorrect word to describe the process…try retardation of medical care.

By: Long Time RN

Long Time RN — Thu, 12 Nov 2009 13:46:55 +0000

S.,
Agreed that information systems can be a hinderance in charting however, the sheer automation and importation of discreet data elements into a patients record in a legible and actionable form are “an improvement in itself” from the paper based method. Remember now that I never mentioned a company as there are many large vendors wtih systems that still look and feel like dos.
My point is this, human error accounts for a large percentage of the medical mistakes made, either from illegibility, non standardization of terminology, and a lack of checks and balances. This is what automation in itself can offer when used properly. Additionally, a lack of critical decision making tools to accurately intrepret all of a patients data on one screen and the inability to quickly complete research, and the lack of ability to incorporate JCAHO, CMS, complainces along with the quality intiiatives into an eletronic system for all users to comply simply cannot be done on paper with the same effect that electronic records can. There are IT choices out there that truly return the RN and MD to the bedside and eleminate the administrative duties that are often demended of them and a poor use of resources while helping to improve patient outcomes.
So this is a brief explaination to my point the IT is an improvement in itself. The caviate is that there is no regulation forcing the small and large vendors to provide seamless web transactions between each other systems for the sake of continuity of care making things more difficult. This inhibits the user experience by not allowing for data to flow from one app to another requiring that the same questions be asked over and over.
IT in it’s current form is not the absolute answer yet automation can virtually eliminate human error, streamline business practices, provide decision support and standardization and is “an improvement in itself”. No I certainly do not have an overconfidence in a machine becuase the machine has nothing to with the software package that has been deployed for clinical documentation. There is very good software out in the market. The best I have seen and used are from niche vendors that actually focus their attention on a limited scope of documentation. The big guys who sell light bulbs, mops and clinical documentation appear to be the safe bet and why the CIO who wants to be able to point a finger when things go badly chooses them. IT still has a ways to go in developing a solution that is perfect but if you shop around adn truly learn the market you will find a few vendors that are getting it right.

By: S Silverstein

S Silverstein — Wed, 11 Nov 2009 17:58:27 +0000

Jon Patrick’s piece “A Critical Essay on the Deployment of an ED Clinical Information System ‐ Systemic Failure or Bad Luck?” is back online, now in ver. 5 at http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 .

Apparently the issues Down Under that led to its withdrawal have been resolved.

Long Time RN, your statement “IT is an improvement in itself” seems to reveal a subtle overconfidence in these machines.

They are most assuredly not “an improvement it itself.” They have potential to both improve, or to impair, any environment in which they are deployed.

I would be interested in your concise explanation as to why you would think IT is an improvement in itself.