Electronic Records

Let's talk about the paperless chart tonight - the good, the bad and the ugly. Which one should we start with? Well since I'm forever the optimist, let's look at some of the good.

Wow - what would it be like if our medical providers had computer access to every patient's medical record, with the patient's permission of course - their medical history, doctor's notes, their medication lists, their lab and imaging reports?? What if every patient had a scanable medical ID card that had their personal information on it - like what insurance coverage they have, who their Primary Doctor is, emergency contact information and maybe even some important medical information like allergies, DNR status, etc...?

Just that in itself would be pretty amazing!

Just think how much money we could save in repeated tests between providers. Not only can we see what prior tests were done, but also the results of each test. Do you know how much money repeated tests cost the patient, the insurance company, the hospital? A lot. If you think this is not a common occurrence, you would be wrong. Every time, we receive a patient from another facility, we repeat, at the very least, lab tests and x-rays - not to mention the more costly tests like CT scans, MRIs and Echos, Treadmills, Angiograms. None of these are cheap.

As someone who works for a hospital that's already went mostly paperless, The electronic chart is pretty wonderful on many levels.

We're saving trees - and lots of them. No more file rooms - everything is online. Whoo Hoo!

It's nice to be able to read everyone's hand writing. How much time have we all spent standing around a nurse's station passing a doctor's order sheet around so that everyone could try to figure out what he/she had written. How many times have we asked the patient what medications they take because we aren't quite sure what the doctor wrote. This has always been a huge safety issue.

It's also great to be able to see when a patient's lab tests and imaging reports are back so that we can let the patient know - as well as the doctors so they can continue with their patient's care.

Plus the little conveniences of just being able to enter anything in the computer and it's just right there in front of us - an order goes right to the lab, x-ray, the kitchen, other departments. We write the doctor a note. The physical therapist puts their notes in the computer so the doctor can read it right away. No phone calls necessary. We can google disease processes online - print out diets, medication information, discharge instructions, etc.. These are all great time savers.

And maybe the most impressive thing for me about the electronic record - as it should be for everyone - is the amount of medical errors that can be avoided, the amount of people that aren't injured, maimed or killed by a medical error, the money that it would save patients, insurance companies and facilities. I would think, this in just itself, would be a huge cost saving for our health care system. Think of the lawsuits. Multiple studies have shown anywhere from 7,000- - 30,000 deaths occur annually in hospitals alone due to medication and "other" medical errors. Medication errors alone harm 1.5 million annually and cost the Health Care System between $77 - $177 Billion annually. Yikes ! This doesn't even take into consideration the deaths that are caused by hospital acquired infections or medical equipment or supply errors. This is just charting related or medication errors. The electronic record will significantly cut down on these adverse results. The doctor's medication orders now are entered into the computer, they get sent directly to the pharmacy where the pharmacist verifies the medication order. This order goes directly into our medication machine on the unit - the Pyxis. From there, the nurse can only take out medications for that patient - and then the patient and the medication is scanned at the bedside for additional patient safety. The computer tells us if we scan the wrong patient, the wrong medication - and if there is an allergy alert on the chart. Time consuming - yep - but well worth it if it keeps me from making a mistake that could cause a patient harm.


OK - now the bad.

Sometimes the electronic charting has many obstacles - well not just sometimes, but every day and multiple times throughout the day. The carts need plugged in. The batteries go dead. The carts are out of range. The system goes down. We chart on the wrong patient. The medications won't scan. They change the program and don't tell anyone. And there are times when it seems it takes longer to chart on the computer. I'm guessing sometimes the patients feel like we're paying more attention to those darn computers then them. But all in all, we get used to these things the longer we use them. Hopefully, eventually we get more user friendly software programs and better wireless networks.

Then - there's ugly.

I'm guessing that would be the compromising of patient information due to easier access. Of course this is always a concern - and there are a lot of smart people out there who can figure out how to steal private information on computers. And there's also just carelessness on all our parts - leaving our computers unattended. Again, hopefully we all get better at all these things. Maybe eventually all of our records will be encrypted and everyone will carry around a little USB drive that has an key to open the encrypted messages. This could protect everyone's personal information better. As we all know, hospitals, credit card companies, businesses, banks and government agencies have safeguards in place to help protect our privacy.

So anyway, there it is in a nutshell. Did I miss anything - good, bad or ugly??? I'm sure I did. Let me know. Good Night!