an intern just venting: medical charting way too fragmented

[FreakFlag]

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internship has been fun so far. hwoever, the medical charting system at my place is DRIVING ME CRAZY. orders and notes are all handwritten. labs are online. sounds good in theory, but i feel like a cow on ice...

i can't get the information i want in the speed that i want due to bottlenecking inefficiencies in the way patients' information is distributed (in other words, i don't know how to work this system yet). information is totally fragmented across paper, computer, and "ask the nurse."

paper charts are impossible to track down and do not have RF tags on them. they are the exclusive source of some of the most critical information needed to care for a patient. come on, it's 2008...this information should be digitized on the EMR. it's a waste of time playing hide-and-seek with charts.

what else...once i finally find the chart, i can't read it. i cannot for the life of me decipher most of the paper notes in the chart due to everyone's illegible handwriting. is it common practice to make your notes illegible as a form of defensive medicine?

and vitals are never in the same place. on some floors or units they're buried somewhere in the chart, otherwise in the EMR, else on a clipboard separate from the patient's chart. the neat thing about these damn clipboards is that they DO NOT DISPLAY THE PATIENT'S NAME OR ROOM NUMBER on the surface. i think this is done to be HIPAA-compliant. as a result you actually have to rummage through the stack of clipboards by hand, flipping each label to read it as you go, to find your patient's vitals.

the computer EMR blows chunks due to poor design. for example, why do i have to manually and REPEATEDLY resize every window so text displays properly instead of word-wrapping in a tiny 2-inch wide box, etc? why is the text displaying in comic sans serif? adding to the insult is that it takes forever to load something everytime you double click...like i'm at 2400 baud or something.

dear god, please have Apple design an EMR, and please have my hospital install a gigabit network.

thank god that the nurses i've worked with are super helpful and provide concise and coherent information. amen.

signed,
cry-baby intern

 

[IndyXRT]

Sounds like my hospital. Oddly enough, the only thing more painful than the system you describe is transitioning from that system to a "completely paperless system." We'll be enjoying the fun and games for months to a few years as they roll this thing out floor by floor.

 

[radslooking]

i have worked in a place like this and it does make your day unbelievably annoying. people do not understand when you are performing about 500 separate operations (not surgical operations) and the time to do those operations increases by even a few seconds, that adds tremendous amounts of time to your day.

i had a similar system....one computer system for labs, one system for h and p's and discharge summaries....the paper chart for recent notes, the paper chart for orders, and a separate clipboard in the "med room" for medications, and a chart beside the hospital bed was where the vitals were. Of course, viewboxes with a separate password was where you checked the radiology studies.....

and of course all the computer systems required separate and usually somewhat different passwords. i dont know how people think this is ok.

cprs is the best system thus far. im afraid we'll all be waiting a while until these computer systems improve.

i have to say...if there was a way of integrating these computer systems nationwide that would help a lot. im not sure that the private model of different systems everywhere is a good idea because each hospital is different. Im not sure hospital medicine is the arena to practice free-market development of EMR's. One system...such as CPRS, may not be perfect, but at least it would allow transfer of information from one hospital to another.

 

[gutonc]

Sounds like my hospital. Oddly enough, the only thing more painful than the system you describe is transitioning from that system to a "completely paperless system." We'll be enjoying the fun and games for months to a few years as they roll this thing out floor by floor.

We just installed an EMR at our Univ hospital and it was way less painful than anyone expected. Not flawless mind you, but not horrible. We're now 3 mos out and almost everyone wonders how we got by w/ our old system of paper notes and orders, MARs on paper and in a different location depending on the floor (med room, bedside chart, nursing station chart), PACS system, a system for clerks to use to enter orders and yet another one to check labs...and VS usually on a paper towel in the patient's bathroom.

 

[MR1]

...and VS usually on a paper towel in the patient's bathroom.

Why is this so universal, seems like the techs or RN's do it everywhere.

sorry the above is off topic... our univ just went to an EMR a few mths ago and it was somewhat painless as well. We still have the old labs system though, PACS, and outpatient system with different passwords. Hopefully with time it will all be come together better.

 

[IndyXRT]

our univ just went to an EMR a few mths ago and it was somewhat painless as well.

I will dare to hope.

 

[DrDre311]

Why is this so universal, seems like the techs or RN's do it everywhere.

sorry the above is off topic... our univ just went to an EMR a few mths ago and it was somewhat painless as well. We still have the old labs system though, PACS, and outpatient system with different passwords. Hopefully with time it will all be come together better.

You will never get away from this kind of ****. Also EMR is not a quick fix because you're still dependent on the nurses actually entering vitals and I/O's which almost never happens in time for morning rounds. I could never understand how nurses on a surg floor couldn't figure out that teams always round around the same time and we always want the same ****: I/O's, Tmax, basic vitals. Not having timely I/O's always drove me nuts when I was the guy having to collect that crap.

 

[fab4fan]

Why is this so universal, seems like the techs or RN's do it everywhere.

sorry the above is off topic... our univ just went to an EMR a few mths ago and it was somewhat painless as well. We still have the old labs system though, PACS, and outpatient system with different passwords. Hopefully with time it will all be come together better.

Ususally because the chart is nowhere to be found. It's a universal frustration.

If you want to know what someone's VS are, you can just look at the back of my hand--that's another good place to jot them down! 😉