A Country Doctor Writes:

Friday night:

I had a good day. I was typing in the exam rooms with both thumbs, and sometimes dictating, on my new iPad mini and getting most of my notes done in real time. The phones were ringing off the hook, as we say in America. My 3-5 pm administrative time, earmarked for working with our IT and EMR manager, was up for grabs since she was away at a conference. We opened it up to take care of the patients that were calling in. I saw 25 patients and the last one left at 5:06.

I sat down at my desktop computer to respond to messages, check some of the 50+ documents and 100+ lab reports in my electronic inbox. I was out the door by 5:45 and as I drove home I enjoyed the fall foliage illuminated by the warm red glow of the early sunset.

After dinner, as I was preparing the horses’ mash, the answering service called. Cityside ER wanted lab results on a patient I had referrred up almost six hours earlier.

“Didn’t you receive my fax with two office notes, an EKG and all the bloodwork?” I asked.

The answer was no.

“I can fax it from our EMR through my iPhone app”, I told her. “Call me on my cellphone if you don’t get it.” Within minutes I had sent everything and they didn’t call, so I felt pretty comfortable that they got it. A couple of months ago I had sent records to Mountainview hospital the same way and that time I had called them to make sure the system worked.

Moments later, I got another call from the answering service. Rural Hospice needed more morphine concentrate for a patient of Dr. Kim’s. They wanted me to send it to the nearest pharmacy instead of the regular Hospice outfit, so they could be sure to have it on hand by Saturday morning. They offered me the phone and fax numbers of the pharmacy.

“I don’t need that, I can send it straight from my iPad”, I said, confidently. The Hospice nurse sounded impressed.

I have sent controlled substances from the iPad many times during office visits. This was the first time I tried to do it from a phone message I just created for myself. It didn’t work. Normally, I get a pop-up screed where I have to type in my EMR password and a number from a miniature number generator, or Hard Token, as the lingo now goes. I just didn’t get to that screen. I tried my iPhone app, and it just said the prescription went, but there was no popup, so I knew that script wouldn’t be honored.

I hardly ever bring my company laptop home with me, and we have only Apple products in the house. So I dusted off my MacBook and logged on via the web browser version of our EMR, which no one in our office uses, and I have only looked at it briefly.

I started another telephone encounter and picked morphine sulfate concentrate from the pick list. The directions listed there were not the same that Dr. Kim’s patient needed, so I double clicked on the drug name to get to the “edit” screen. A big red box popped up, telling me I was not authorized to change dosages and needed permission from my Administrator. So much for that.

I sent the phone message with the failed script to myself, opened it up on my iPad and fiddled with it again. I tried several times to change the pharmacy from the default one to he new one that the patient had never used before. I realized I didn’t know how to enter an brand new pharmacy. It took several tries before that part worked. So, again, I tried to send the script. This time, suddenly, and without me knowingly doing anything different from before, I was able to not only change the morphine dose, but I also got the pop up screen for prescribing controlled substances.

I still had a nagging doubt, so I called the pharmacy and left a message that if they didn’t get an electronic prescription for this patient to please call my office Saturday morning.

After all, I thought to myself, this new technology is pretty handy.

After feeding the horses their belated supper, I sat down in my little den next to the stalls and wrote the first draft of this post. I hesitated a bit about the question mark in the title, but I figured I’d sleep on that one.

Saturday morning:

An hour into my seven hour Saturday clinic, Autumn told me the pharmacy was on hold on line 1. They were calling about my message. They had not received any morphine script overnight from me.

Oh well, I guess he question mark stays.