quick ? and medical school

Vic Nicholls nichollsvi2 at GMAIL.COM
Wed Apr 30 18:41:41 UTC 2014

The one item missed in all this is that future medical professionals are 
going to be trying to make heads/tails out of this mess. If they can't 
figure it out, then it is harder for them to dx the patient. Imagine if 
you are ER and someone is trying to wade thru this?

Not fair to them.

Not fair to the patient either if they say one thing, EHR says another, 
and guess what? The patient is correct because the software was 
incorrect (could have been the typing also but I'd go first for the 
transcription software). However, most docs want to believe their fellow 

So wants to be the doc in the hot seat when that happens and you make 
the wrong call as the EHR is wrong?

{{shaking head}}

I think EHR's could be great, but how do we work them so that obvious 
errors are fixed? One of my favorites in my records was "treating white 
count with family". If you are healthy you can ignore it, but if the 
person has a heme/onc? Its 7 pm on a Friday night and the office is closed.

The actual comment that the doctor made was that he was treating me like 
he would his family. Any one guess that one?

On 4/30/2014 1:16 PM, Shapiro, Barbara wrote:
> 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

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