Old Information

“Did you ever take a betablocker, like atenolol, or Topamax for your migraines”, I asked.

“I think so, and something didn’t agree with me”, she said. “It was, like, ten years ago.”

We got our first EMR in 2011. Neither drug had been prescribed for her since then.

“Let me get your paper chart”, I said and left the exam room. Walking past the reception desk, I grabbed the pink “necklace” with the key to the “chart closet” down an empty hallway of the old hospital building that is now our clinic.

Her paper record consisted of four volumes and measured about 6” in thickness. Once back in the exam room, it took me less than a minute, leafing through the medication flowsheets to the left inside each folder, to find the pages where atenolol and Topamax were listed in my own and Autumn’s handwriting.

Checking the dates on the flowsheet, I quickly found the office notes, stacked in reverse chronological order to the right in the same volume of her chart. And there it was, the story of her atenolol, which relieved anxiety related tremors but did little for her migraines. We kept that drug for those benefits and added low dose topiramate. Shortly thereafter she had a spell of low blood pressure and stopped both drugs on her own.

I had the information I needed. The walk down the old hospital corridors took longer than the chart research itself.

I told my new colleague, who is much younger than my children, how easily I found the information in the paper chart.

“Let me look, I’ve never seen a paper chart”, she said. Neither had her medical assistant.

Later, I told the story to my office manager, who remembered the admin staff’s frustration back in the day with locating the records themselves. I do remember occasionally having to see a patient without their paper chart. But, of course, that happens with electronic records too all those times when our EMR is down.

At least in my current system (me again, Greenway), it is exceedingly difficult to imagine timelines that the system fails to display in logical fashion – of medication starts, dose changes and discontinuations, as in my patient’s case, or with clumsy EMR warfarin “flowsheets” that take much longer to work with than the old paper version.

There is so much more that could be done with the User Interfaces in today’s systems. We still work with what feels like MS-DOS while my grandson’s X-box is so intuitive that, literally, a child can work the system.

EMRs: It’s the Interface, Stupid*

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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