A Near Miss, Technology Notwithstanding

The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab.

Printing a requisition from our EMR is a multi step process that involves leaving the “superbill” (I don’t know what’s so superior about it, but that’s a different topic), going to “chart”, clicking on “requisitions”, highlighting the “creatinine” I just ordered, selecting “in-house lab” even though the requisition is meant to bring to the hospital, selecting “ok”, then getting transported to another screen where I must again highlight “creatinine“, clicking “print”, getting to a pop up window that says “could not find a printer…”, clicking on the name of the only printer on the network I ever use (immediately to the left of my desk back in my office), clicking “ok” and walking down the hall to get the piece of paper, signing it by hand even though it says “electronically signed” and (finally) giving it to the patient.

The next day we got a fax from the x-Ray department with their premedication protocol for iodine allergic patients. I had missed the fact that my patient had an allergy to iodine.

I simply missed the fact that my patient had this allergy, and he didn’t catch my comment about “iodine contrast”. I should have asked more specifically about iodine allergy, and I should have made the detour from “superbill” to “medications” to “allergies” before going to “chart” to go through the steps of ordering the creatinine, but this time I didn’t.

My million dollar system, which doesn’t even have a spell checker, doesn’t know that a CT with contrast requires a creatinine and is contraindicated if the patient is allergic to iodine. It makes me follow a “workflow” that reminds me of my High School introduction, in the early seventies, to the early programming languages of the day (COBOL and Fortran, if I remember correctly) and my first Atari home computer. It is far removed from the $500 iPhone I carry on my belt.

In the days before our EMR, filling out a paper requisition took only a few seconds and gave me more time and mental space to chat with the patient about the test itself while I was completing the task. With the archaic workflows of my EMR, my attention is drawn away from the clinical scenario to the not-so-smart computer in the room.

What was supposed to make the practice of medicine safer and more efficient is, to date, only a gleam in the eye of software designers, politicians and clinic administrators. For those of us in the trenches, it is at least some of the time just a bunch of extra work with very uncertain benefits.

1 Response to “A Near Miss, Technology Notwithstanding”

  1. 1 meyati February 8, 2015 at 5:02 pm

    I agree that software is not patient nor doctor friendly. My Microsoft Soft programs at home have the same printing flaw. Print this page>no printer available> delete that and click on print again> this time it opens a page to print> then it actually prints.

    My Radiology Oncologist has Elfrida, his head nurse. She even sets up scans for my preference. I like to have 2 days to read the radiology reports before the visit.

    I remind Elfrida that my appointment is in 6 weeks. She gets the authorization and puts in the work order for my BUN-Creatine, and she makes the appt for the scan., I usually get my other lab work (I have only one vein).
    I go in for my scan. I had to visit the manager-they were setting my head at the wrong angle. All we could glean before was that my lip was cancer free.
    I read my report. This last time I didn’t have questions. Before one question was, “Who orders the the angle and position of my head- Santa Claus?” The report said that the angle compromised the readings- a waste of time- tax money—When I was getting ready for my scan– again I said that I had cancer inside my nose and part of my nose was cut off and my nose was sewn back into my face. My doctor told them that, I wrote that on the scan paper work, then I told them and told them. The tech thought that I had a precancer removed from the tip of my nose. I guess I shook up his boss, and his boss shook him up. For once my head was adjusted-fine tuned-instead of being plopped down with my nose pointed up.

    I’m happy that your system did catch the iodine allergy, but you need an Elfrida that goes over these things with the patients to reduce these possible accidents of the patients sliding through the cracks.

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