Comments on: EMR: PROGRESSIVE PANACEA http://www.healthcarebs.com/2008/03/15/emr-progressive-panacea/ Cleaning the Augean Stables of the Health Care Debate Wed, 03 Dec 2008 07:46:33 +0000 http://wordpress.org/?v=2.3.3 By: Nurse K http://www.healthcarebs.com/2008/03/15/emr-progressive-panacea/#comment-62664 Nurse K Sat, 15 Mar 2008 15:50:15 +0000 http://www.healthcarebs.com/2008/03/15/emr-progressive-panacea/#comment-62664 These EMRs don't just appear on the scene. It cost our hospital alone millions to implement, including the costs to add more staff to the hospital for a month or two so people could learn the program and not be overwhelmed with the usual load of patient care. The same would go with clinics and everywhere else. I personally don't mind it that much, but I catch so many mistakes, far more than I had to worry about before. It's easy to open the wrong chart and order a whole bunch of stuff on the wrong person and, low and behold, a patient is getting dig or metoprolol when it was intended for the guy next door. Luckily, the doctors are getting better about this, but it still happens frequently. Also, the things like the Q6hr PRN defaults mentioned above: When that happens, the pharmacy doesn't receive a flag that the medication is "stat" for the ER and the order goes unfilled until someone changes the order and this causes delays. This happens at least 2 or 3 times per shift just on my patients alone. Another subtle problem includes the standard order sets for diagnoses. If your patient is listed as "infection", an entire default order set for sepsis will pop up and the doctors will click on far more tests in that order set than I think they probably otherwise would have. A little old lady with normal vitals (except a temp of 99.2), cough and body aches got a million-dollar sepsis work-up from ionized calciums to lactates a couple days ago, for instance when all she needed was a flu swab and rest. I personally don't mind our system and most of the younger doctors like it, but it's far from idiot-proof and doesn't decrease mistakes. These EMRs don’t just appear on the scene. It cost our hospital alone millions to implement, including the costs to add more staff to the hospital for a month or two so people could learn the program and not be overwhelmed with the usual load of patient care. The same would go with clinics and everywhere else.

I personally don’t mind it that much, but I catch so many mistakes, far more than I had to worry about before. It’s easy to open the wrong chart and order a whole bunch of stuff on the wrong person and, low and behold, a patient is getting dig or metoprolol when it was intended for the guy next door. Luckily, the doctors are getting better about this, but it still happens frequently.

Also, the things like the Q6hr PRN defaults mentioned above: When that happens, the pharmacy doesn’t receive a flag that the medication is “stat” for the ER and the order goes unfilled until someone changes the order and this causes delays. This happens at least 2 or 3 times per shift just on my patients alone.

Another subtle problem includes the standard order sets for diagnoses. If your patient is listed as “infection”, an entire default order set for sepsis will pop up and the doctors will click on far more tests in that order set than I think they probably otherwise would have. A little old lady with normal vitals (except a temp of 99.2), cough and body aches got a million-dollar sepsis work-up from ionized calciums to lactates a couple days ago, for instance when all she needed was a flu swab and rest.

I personally don’t mind our system and most of the younger doctors like it, but it’s far from idiot-proof and doesn’t decrease mistakes.

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