EMR - No Neo-Luddites in Endoscopy: Embrace and Interface

If you are unfa­mil­iar with the term, the Lud­dites in Eng­land of the early nine­teenth cen­tury dis­ap­proved of the indus­trial rev­o­lu­tion, and wrecked fac­to­ries by indus­trial sab­o­tage to protest the replace­ment of their skilled labor jobs by machin­ery. Their attempted social de-evolution led Lud­dites to exe­cu­tion or trans­porta­tion to Aus­tralia. Many today, wish­ing for return to a qui­eter, calmer, slower exis­tence, believe that the Lud­dites may have been on to something.

If you lean toward the neo-Luddite, you might elect to avoid EMR like the plague (In fact, you won't find much dis­pute in med­i­cine that the plague is in fact a good thing to avoid, so per­haps the anal­ogy is not a great one). We all know peo­ple who don't have an email address (gasp!), which in our era is like not being sure how to use a tele­phone or play a CD (Although come to think of it, this anal­ogy may have holes as well.

I'm not always cer­tain how to use the mul­ti­func­tional "Swiss-Army-Knifish" cell phone that I own... really, why would I wish to shoot home movies on my phone, or read books on that itsy bitsy screen. It's just not nat­ural. And daily, I acci­den­tally shut the phone off while speak­ing the brush of an earring... oftentimes sev­eral times per con­ver­sa­tion if I'm par­tic­u­larly bejew­eled in a par­tic­u­larly styl­ish pair.). Oh my gosh, per­haps I'm a neo-Luddite too!

My brother Robert is what I call a selec­tive Lud­dite. Although he works as a high level com­puter pro­gram­mer for a multi­na­tional cor­po­ra­tion, he car­ries a pocket watch, and doesn't even own a cell phone. He is con­fused by con­ver­sa­tions about whether he can join your 'cir­cle', as he lim­its his tele­vi­sion view­ing as well. Given the fre­quent inter­rup­tions of my life by my own per­sonal tor­ment device AKA cell phone, I can see his valid Lud­dit­ian point.

Regard­less of my sta­tus as a neo-Luddite wannabe, I am an EMR cheer­leader. I designed my own one per­son prac­tice to be enhanced by use of new EMR tech­nol­ogy- a tech­nol­ogy which allows the prac­tice to more eas­ily serve our patients, rather than buffer them away. In an office set­ting, when a patient calls, we all may have has access to their chart at the touch of a/several but­tons. Imme­di­ate, real time care can be given, rather than the 'take a mes­sage and some­one may call you back... even­tu­ally'. In addi­tion to bet­ter cus­tomer ser­vice and bet­ter patient care, our prac­tice costs a lot less- less tran­scrip­tion, less chart pulling by staff, and less postage as most cor­re­spon­dence is sent out by fax. Refer­ring physi­cians like our faxed reports as their speed in get­ting results whilst a patient waits in their office is near-instantaneous... and they need only request records in the rare instance that records are not faxed out on the very day that the patient is seen.

Beyond the office man­age­ment and cus­tomer ser­vice logis­tics, we enjoy lifestyle logis­tics. I can check my lab results and write notes where I am right now, sit­ting on my back porch with a wire­less con­nec­tion. My staff can sign on from home to pro­vide clin­i­cal sup­port. My nurse Deb often­times takes patient infor­ma­tion sheets home to do data entry in the evening or late at night for our direct access colonoscopy patients; she can access the office via secured server and a vir­tual desk­top. I myself have kept in touch from the Incan tem­ples of Pe­ruto my rural lake­side retreat. My EMR buys my staff time and flexibility.

My free­dom, in a bun­dle that weighs less than five pounds.

But what about endoscopy? Is the power of EMR being har­nessed wisely in your suite? Per­haps not.

From the doc­tor point of view in your unit, EMR is groovy. We use soft­ware like EndoSoft, allow­ing us to quickly gen­er­ate a report with full color pho­tos based on our own per­son­al­ized tem­plates, and then send that report by fax to our refer­ring docs and hand a spare copy to patients. Quick grat­i­fi­ca­tion. Great cus­tomer ser­vice. Exclude the middleman/woman of med­ical records and tran­scrip­tion. What's not to love? Oh, and our hos­pi­tal loves our endoEMR too, esti­mat­ing that we might be sav­ing as much as $100,000 per year in tran­scrip­tion costs (of course, the sys­tem costs money, but once it's up and run­ning, the pay­back period is rel­a­tively short).

But then I look at my cir­cu­lat­ing nurses work sta­tion and roll my eyes. IMHO, endoscopy nurses and EMR have not prop­erly inter­faced. Anna's cart fea­tures a com­puter screen and key­board for the sur­gi­cal sched­ul­ing com­puter, another com­puter screen for the hos­pi­tal sys­tem (to enter pathol­ogy his­tory data), and yet another screen of sorts for the mon­i­tor, the vital signs dis­played then entered man­u­ally into papers wedged on the remain­ing sliver of space remain­ing on top of the desk. Yesh. Adding another non inter­fac­ing com­puter does not con­sti­tute a use­ful patient care tool; the prob­lem in our suite seems to be a com­mit­ment by the Hos­pi­tal Infor­ma­tion Sys­tems (HIS) folks on mak­ing the inter­face of these mul­ti­ple machines work. Just look­ing at the mul­ti­ple sys­tems, I'm tin­gling with an indus­trial sab­o­tage Luddite-ish urge.

My ques­tion: Do your nurses, par­tic­u­larly the spe­cialty nurses like those in GI, have a seat at your hospital's HIS con­fer­ence table when new tech­nol­ogy is cho­sen and imple­mented? I can­not imag­ine it is so, with the lack of coher­ence I see on that cart across the stretcher from me each day.

What to do? Have your endoscopy unit man­ager con­tact HIS and hos­pi­tal admin­is­tra­tion, and make sure that inter­ested and tech savvy nurses are appointed to pur­chase and imple­men­ta­tion com­mit­tees for new soft­ware instal­la­tions at your hos­pi­tal or endoscopy cen­ter. Or appoint a techno savvy endo nurse to inter­face with HIS geeks to work on the endo sys­tem you already have, until a smooth and seam­less inter­face between the mul­ti­ple mon­i­tors is realized.

EMR holds a great deal of promise in med­i­cine. The promise to allow us more qual­ity time with our patients, less redun­dant labor, bet­ter com­mu­ni­ca­tion. But only you can dare to embrace, and inter­face with, your tech­nol­ogy. It's either that or face trans­porta­tion as a Luddite.

Article Source: Patricia L Raymond

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