EPtalk by Dr. Jayne 6/30/22
I’m still in the woods. We have had good weather, so I’m grateful. I ended up sharing some of the first aid duties with one of my favorite nurses. The camp has a new policy about how we document medications that are given the participants and there’s a bit of redundancy to it. One of the volunteers was complaining, but the nurse mentioned the EHR that she uses in her hospital and the fact that she’s used to documenting the same thing in multiple places. I literally laughed out loud. I’m sure the other volunteers thought I was suffering from the campsite psychosis that typically develops late in the week, but it made my morning.
I hopped on a work call to help with some testing in the production environment. In the software world, companies sometimes refer to “eating their own dog food,” while one of the other volunteers who is a software engineer said that his company refers to it is “drinking their own champagne.” I hadn’t heard that one before, but I like it, although it’s pretty presumptuous to assume that what you’re releasing is top shelf. I’ve used plenty of software that’s closer to Three Buck Chuck than it is to Dom Perignon.
My organization is bringing up some new features and has a solid plan for the go-live, so while we were troubleshooting a small issue, we were talking about past go-live experiences. We collectively decided that intensive care unit go-lives are the most nerve wracking, although those on the labor and delivery unit are a close second. One of the major challenges with changes to the system for L&D is that you have to be able to immediately document on a patient who didn’t exist just moments before, and for whom you have no information. It’s similar to managing a John Doe patient in the emergency department, although the odds of having a John Doe during a go-live are significant smaller than having new babies arrive.
After more than two years dealing with the COVID-19 pandemic, hopefully EHR developers and those who support ambulatory clinics will be able to swiftly make the changes they need to combat the growing monkeypox outbreak. More than 50,000 doses are being shipped to states with the highest case rates, which means that systems need to be updated to document their administration. I’ve worked with a couple of niche EHRs where the vaccines are hard coded or difficult to configure, so I hope the clinics that receive the doses have systems that make it easy to capture such important patient care information. Plans are in place to distribute more than 1.25 million doses in coming months. I hope we can get ahead of the problem rather than be in reactive mode like we were for COVID.
This article caught my eye, noting that half of public databases in the US misuse gender and sex terminology. This is one of my pet peeves. I’ve worked with vendors who do a good job understanding the difference between the two and those that don’t. The authors looked at 75 databases used in biomedical research and also looked at journals to see if they had author guidelines that addressed these factors. Understanding sex and gender is important to better quantify the ways in which sex and gender drive clinical outcomes.
For those who need a quick review, “sex” refers to biological attributes such as anatomy, chromosomes, hormone levels, and gene expression. “Gender” refers to expressions, identities, social roles, and behaviors. I hope that the software vendors who continue to use these values interchangeably will eventually get it in gear.
I’m keeping it short this week since I need to get back to my camp duties. It’s been great to see how the participants are already growing and learning new things. The group I ate breakfast with this morning made my day. Since they knew that I was their assigned adult, they cooked my pancakes in the shape of a J. When you have the chance to work with people who have that level of commitment to caring for others, it gives you hope for the next generation.
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I think you're referring to this: https://www.wired.com/2015/03/how-technology-led-a-hospital-to-give-a-patient-38-times-his-dosage/ It's a fascinating example of the swiss cheese effect, and should be required…