Curbside Consult with Dr. Jayne 4/16/12

I cover the emergency departments of different hospitals. One of my facilities (part of a large health system where, thankfully, I have no responsibility for any of the IT decisions) is about to upgrade its ED information system.

Working there has driven me to near madness. The medication prescribing system is atrocious. It not only contains “do not use” abbreviations, but also doesn’t allow you to prescribe any medications that are not pre-built in the hospital-centric medication database.

Being spoiled by other vendors that use high-quality third-party medication content, it’s definitely a challenge. There’s no ability to free text notes to the pharmacist and no e-prescribing either. Half the time I end up taking the computer-printed prescription form and handwriting comments on it to avoid pharmacy callbacks (most of the patients I see have no insurance and pharmacies are constantly calling to substitute things due to cost — I like to give the pharmacists flexibility to substitute when needed.)

Because I’m a part-timer, I rarely work with the same nursing staff repeatedly. While challenging, it’s rewarding because I’m guaranteed to learn something new on every shift.

Last night, Nurse Tina introduced me to what I can only categorize as forbidden fruit. The drawer under the counter where the physician’s PC sits contains more than just pencils and paper clips — there are (gasp) pads of prescription blanks! Yes, Virginia, there IS a Santa Claus and he just brought me something good. Better than dark chocolate.

I gleefully spent the rest of the shift hand writing prescriptions whenever I ran into an issue with the software, something I hadn’t done in years. Because of the limitations of the prescribing system, not only was hand writing the prescriptions faster, it was better for the patients. I could write exactly what I wanted rather than trying to hijack a poorly built “default” medication selection. I had to find a suitable notes field in the system so that my handwritten scripts were documented and I did sacrifice allergy and interaction checking, so it wasn’t a perfect solution.

The system is due for a much-needed upgrade, which has been postponed twice previously. I hope this time it actually occurs. I will attend training in a couple of weeks and I hope there are good things in store.

I’m a little concerned, however, because I learned from Tina that the non-physician staff haven’t received any notification of the upgrade, nor have they been scheduled for training. That should make things interesting.

Because I’m just a hired gun providing clinical coverage, no one gives a hoot about my IT opinion. That’s frustrating,  but refreshing. It allows me to see the systems as the rest of the physicians do. I’m just  someone just trying to do her job and care for patients. This gives me greater perspective on how my own systems should operate and whether our communication plans, training, and upgrade preparations are adequate.

I’ll know more in a couple of weeks about whether we’ll really have improvements. Hopefully provider-specific medication favorites are coming, or maybe even an actual comprehensive medication database. I’m crossing my fingers and will keep you posted.

E-mail Dr. Jayne.