Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
Another unsolicited email from a physician describing EHR-caused chaos in the clinic

Another unsolicited email from a physician describing EHR-caused chaos in the clinic

I periodically receive unsolicited stories of EHR difficulties (mayhem, really) as a result of clinicians or others locating my materials online, via web searches, social networking sites, or word of mouth.

Here is another unsolicited email from a physician describing EHR-caused chaos in the clinic, reposted with permission.  My comments are in [bracketed bold red italics]:

I am an employed physician and in one of the first groups at [large healthcare system medical center in southern U.S., name redacted] to go live, which we did recently. I am in a three doctor office.

There were various factors involved with the "nightmare", a few of which were likely uncontrollable.    

[In health IT nothing is "uncontrollable" nor acceptable to be deemed that way.  Either you are in control of your information systems, or they are in control of you - ed.]

We are using portable laptop computers and it took over a week for the IT folks to figure out that my associate's tablet/laptop was corrupted somehow. They kept saying her "profile was corrupted" and finally, after they had rebuilt it three times our office manager (who knows the definition of insanity) suggested switching out her hardware.

[An utter waste of clinical and technology time and resources, reflecting inadequate IT talent management - ed.]

Meanwhile, I'm a geek by nature and had no trouble understanding and using the software, I just don't like it.

The problems as I see them, in no particular order, were:

The doctors were trained for three to six hours on PCs in a computer lab. The only reason our group got our laptops before the day we went live is that WE INSISTED on it.  No "dry run" happened before the day the office went live, so there were bottlenecks everywhere.  Front desk, registration desk, MA station, lab draw station and checkout. 

[This again reflects fundamental project mismanagement - ed.]

At start of day only one of the three MA's computers were working. It took half the morning to figure out what the issue was.

[Ditto - ed.]

Administration was insistent that we should see our usual number of patients (I average 20). I simply refused to do so and my office manager gave me 12 (THANK GOD--I've been a physician in [city] for over 25 years, employed by [healthcare system] over six years. I was able to insist and won the battle. Other doctors are not as outspoken as I am so God knows what kind of nightmare they will experience). 

[I think we already know - see my post "In addition to nurses, doctors now air their alarm: Contra Costa County health doctors air complaints about county's new $45 million computer system - ed.]

While the "superusers" were over-the-top helpful and very knowledgeable, if I had not spent a couple hours the week prior to the start date with one of the cardiologists already on the system, it would have taken far longer to learn the system. Physician workflow and understanding of clinical use of the program is imperative [axiomatic - ed.] and I just don't think the IT folks get that. 

[Common but inexcusable.  As I have asked dating to the early 1990's, then why are IT people in charge of clinical projects?  Will hospitals ever learn? - ed.]

We were given tablets/laptops yet no one realized they came with a stylus and were meant to be used that way. No one was trained using it as anything but a laptop.

[At this point, what further can I say about project management? - ed.]

When they encrypted the hardware they did not calibrate them and I still have to click to the left of any box to get the stylus to work (and I think I can calibrate the thing but just haven't had time). Because of the Windows Version we use in our system I can't RIGHT CLICK with the stylus. So I have to switch to laptop mode to refill meds.

[A distracting workaround that can induce cognitive overload and promote errors - ed.]

No one has yet to tell us HOW TO CLEAN THE LAPTOPS!!!!!!!!! (I've looked that up and plan to discuss it with the steering committee). 

[I addressed this unforgivable IT-department deficiency - in the late 1990's - at my recollections on endangerment of ICU patients hereThat recollection in part led me to start writing on the issues.  This industry seems to have a severe and reckless inability to learn - ed.]

We are unable to access any results from our Lab Corps partner because the relay hasn't been set up yet. So lab results that are done in our office have to be scanned in the chart. 

[One could reasonably argue that the "go live" should not have happened with such a deficiency.  Why invite trouble?  - ed.]

No one understood the difference between scanning and abstracting until I talked to the cardiologist who said, "Forget scanning. Get everything you can abstracted before you see those patients"

There are a whole host of "little" things that are wrong with the software, like the fact that the default on refills is "record" so if you are refilling five medications you have to remember to re-click "send to retail" or "send to mail order" EVERY time. Of course my patients are going to the pharmacy and only half their meds are there!

[An 'inconvenience' that could conceivably lead to a medication mistake event - ed.]

Plus "clinical summation" sucks on this system. I don't have a flowsheet for preventive services. Seriously?????!!!!!! 

[Seriously - unfortunately.  Summarization capabilities of commercial EHR's is suboptimal.  See my Feb. 2012 post "It's Remarkable That EHRs Can't Do What Med Students Are Taught in PGY3-4 ... And Remarkable That Academics Don't Push This Information to the Public" regarding an Applied Clinical Informatics article "Clinical Summarization Capabilities of Commercially-available and Internally-developed Electronic Health Records" - ed.] 

[One issue not raised:  what about ongoing risk to patients, patient rights, and/or any bad outcomes? - ed.]



My belief is that situations like this are common, but go unreported due to physicians not knowing to whom or to where reports might go.  (I made recommendations on that score at my post here.)

This physician serendipitously came across my materials via social networking,but most accounts - critical risk management relevant signs of systemic problems in the health IT sector - likely never get made, let alone reported.

This is why robust post-marketing clinical IT surveillance, and education of users about same, needs to become the norm.