Dark Brightness

I still beleive in paper notes. The cure for illegibitly is called a dictaphone and a typist. Typing onto paper. Or a printout.

FOR 20 years, I practiced pediatric medicine with a “paper chart.” I would sit with my young patients and their families, chart in my lap, making eye contact and listening to their stories. I could take patients’ histories in the order they wanted to tell them or as I wanted to ask. I could draw pictures of birthmarks, rashes or injuries. I loved how patients could participate in their own charts — illustrating their cognitive development as they went from showing me how they could draw a line at age 2 and a circle at 3 to proudly writing their names at 5.

Now that I’ve been using a computer to keep patient records — a practice that I once looked forward to — my participation with patients too often consists of keeping them away from the keyboard while I’m working, for fear they’ll push a button that implodes all that I have just documented.

We have all heard about the wonderful ways in which electronic medical records are supposed to transform our broken health care system — by eradicating illegible handwriting and enabling doctors to share patients’ records with one another more easily. The recently passed federal stimulus package provides doctors and hospitals with $17 billion worth of incentive payments to switch to electronic records. The benefits may be real, but we should not sacrifice too much for them.

The problem is not just with pediatrics. Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient.

via Op-Ed Contributor – The Computer Will See You Now – NYTimes.com.

This is a must read article. And confirms my reasoning for keeping my records on paper.

And ignoring the hospital approved forms. The traditional notes work. Read the whole article.

The root of the problem I experienced with health information systems is a very bad data model. Evidence supporting my claim includes these observations:

Incoherent database design isolates patient information from one department to the next and from one organization to the next. This wastes time and increases errors because medical personnel must enter patient information into a unique view of the system that corresponded to user identity and department – this prevents one medical professional from seeing patient information input by another medical professional.

Patient information is easily lost inside the electronic records system

Hard copy patient information becomes dissociated with the electronic record

A healthcare professional’s work pattern is not reflected in either the system design or data model – people spent considerable time searching and data reentry

No master data management MDM in evidence – Production of a consistent record of me as a patient required the ICU nurse to copy data from multiple database views into the in-patient record

Admitted in-patient records are treated differently by the system than out-patient or ER record only patients – no information about my medical history gathered during a prior visit to ER was available to my doctors or nurses.

Nurses and doctors do not have ready access to listings of pharmaceuticals which wasted much time while they searched for information about my daily medications – lists of medications in the system are limited to those at the hospital pharmacy.

No support existed for recording allergies differently than to ambient source and foods – Lists of allergies were not in drop down menus although these are well known by allergists and drug companies.

The root cause of these problems is the failure by information technology IT system architects to correctly capture business requirements. There also is evidence that no one ever produced a reliable conceptual data model. The problem commonly occurs. Too often, system architects simply gather lists of requirements then they ask their favorite vendors to quote a product. This is non-architecture and system non-design. Rarely do architects request information architecture.

Fault also rests with independent software vendors ISVs whose products fail to support end- user requirements – real doctors, nurses, technicians, and pharmacists. Rather they build products to a marketer’s or a developer’s best guess about end-users’ requirements. It is easier to rush a product to market that “looks good” to IT people but horrifies end-users.

via Analysis from the Bottom Up | The Data Model That Nearly Killed Me.