quick ? and medical school

Pauker, Stephen SPauker at TUFTSMEDICALCENTER.ORG
Wed Apr 30 17:56:01 UTC 2014


Sadly the goal of the medical record has changed from facilitating reasoning to documenting compliance. Its former purpose has not fallen to other tools sufficiently. This is the effect of incorrect measures and inappropriate goals.

Steve



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-----Original Message-----
From: Shapiro, Barbara [Barbara.Shapiro at UHHOSPITALS.ORG]
Sent: Wednesday, April 30, 2014 01:47 PM Eastern Standard Time
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] quick ? and medical school



I use dragon with our EMR.  As it turns out, our EMR is not very compatible with the dragon. There are numerous errors. It is almost impossible for me to go back and edit my dictations, because the edit window on the EMR we use is so small, that the notes are almost too small to read, unless you're on the "view" screen, which you can't edit in. Who knows why it was designed this way, I guess because it's cheaper.  When we first started using this system. I was on the phone with the legal office several times a week, pointing out the legal mine field we are walking through using this system.  Some of the errors are just funny, but others are such that you can't even figure out what the patient's chief complaint is or what the doctor was thinking when they saw the patient. And some of the errors are just plain that - actual errors - because the dragon heard it and transcribed it wrong, and it was never corrected, and it clearly puts the patient at risk.  Now I use a disclaimer on all of my notes - basically it says that the record may not be accurate.  I don't know if that works or not - it's just what I devised to protect myself and the patient. I don't think other doctors in my institution are using any kind of disclaimer. Nor is this an ideal solution. But it's all about saving money.  If the system can turn me into a transcriptionist and proofreader, without paying somewhat to do that - and believe me, they don't pay me any extra to do this - well then, that's the way it's going to be. And it DOES make a huge difference in terms of how I think about patients, if I'm sitting with a pen and paper in my hand, or sitting in front of a computer screen checking off boxes like a chimpanzee, making sure I have all my "meaningful use" boxes checked correctly, basically wasting my time with this useless nonsense rather than concentrating on the patient and why they came in to see me. I agree, the EMR does make more information available to me, theoretically, and I clearly see the positive aspects of this, but there is just so much wrong with the EMR, and so much wrong with the government getting in our business and deciding what is "meaningful use" so that later they can go back and collect statistics on our patients - I don't really know if the risk outweighs the benefits.

sBarbara E. Shapiro, M.D.,Ph.D.

Associate Professor of Neurology



Confidential Quality Assurance Peer Review Report Privileged Pursuant to O.R.C. Section 2305.24,2305.25,2305.251 and 2305.252

________________________________________
From: Vic Nicholls [nichollsvi2 at GMAIL.COM]
Sent: Wednesday, April 30, 2014 10:57 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: [IMPROVEDX] quick ? and medical school

Dr. Carroll: I saw what was supposed to be "patient ran into a cement pole" changed to "patient ran into a semen pool". Maybe proofreading would be good? There should be some reasons why one could petition a court to have some things removed and frankly I think that's one that could be lodged as a true correction.

Because you know that makes the rounds for jokes as one of my ER visits did.

Dr. Bell: great point. If doctors used EBM, I think you'd be on safer grounds than not on a lawsuit. If the evidence backs your opinion, that's good, because it would beat anything else. I mean you went by experts, etc. and your judgement agreed with that.


On 4/30/2014 10:47 AM, Robert Bell wrote:

That is a good point. Insert all the evidence based medicine information and cost effective common sense, etc. in the simulation programs since training.

Rob Bell




On 4/30/2014 10:36 AM, Carroll, Thomas wrote:
I agree it is the physician’s responsibility to record his/her impressions, plans, etc.  However, it is my impression that EMRs are not designed for this purpose.  Pointing and clicking is certainly not helpful for me as I think through a pt’s case, nor does it generate useful information for others in the future to figure out what I was thinking.  It does, however, provide easily searched information for billing, meaningful use, and other (largely meaningless) purposes.

I either dictate (which now with Dragon generates some funny but ultimately embarrassing turns of phrase) or type.  Neither is particularly efficient when compared to a human transcriptionist…but they are cheaper.

Thomas M. Carroll M.D., Ph.D.
Assistant Professor, General Medicine & Palliative Care
University of Rochester
thomas_carroll at urmc.rochester.edu<mailto:thomas_carroll at urmc.rochester.edu>
Pager 5-1616 #3872
Tel: 585-275-7424 (General Medicine Office)
Tel: 585-273-1154 (Palliative Care Office)



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