Query

Figure. Photo by: Fred Sebastian

Our Electronic Medical Record is a comedy of errors. Ha, ha, ha.

I've ranted about this before, but the frustration our system causes is so severe that I need to vent again.

I'm not getting all of my lab results. Here's what should happen: over dedicated phone lines the lab downloads all lab results, be they for blood work, Pap smears or EKGs. These results are supposed to be sorted by doctor and date of service, and by whether they have already been „seen” by a doctor or are „unseen.” (This is the equivalent of a signature on a paper record.) Yet all the results are being sent to just one doctor, and the rest of us in the practice are receiving none. Each of us must click on that doctor's name and search through a humongous pile of agglomerated lab results (for ten different doctors) to find our own.

This is a chore, but it is doable. Believe it or not, it's a minor reason why I hate the EMR. But it brings me to the major reason: I'm not getting all of my results in this maddening way. I'm getting only some of them. The rest are going missing. I made a preliminary referral the other day, without all the blood work having come back, and I held on to that referral pending the remaining results. But they never came, and I had to call the lab to get them. Perhaps this doesn't sound particularly scary. But consider: this is probably just one example of many wayward results, one case that I'd happened to keep tabs on.

So far I've had four cases of patients returning for blood results that weren't in the computer. Frightening. Therefore I've been forced to tell patients that the records system is haywire and that they have to return — every one of them — for their blood results to ensure that lab reports truly do get looked at.

Now this is bad, embarrassing, even dangerous, but it's not the ultimate reason I despise the EMR. The capper is this: No one wants to take responsibility for the problem. The software company we employ — the authors of the program —blames the lab for the problem; the lab, for their part, blames the software. In the meantime, I'm the one ordering tests, the one who must assume responsibility for the consequences of a problem that really, truly, shouldn't be my problem at all.

It took weeks just to get the software people and the lab people to work together to try to sort the mess out.

In the meantime, we've been forced to hire a person specifically to do a manual check to make sure that results actually appear in the system for all patients who have had lab work done. This means I get an electronic copy of results in addition to a paper copy, thereby duplicating the number of results I must go through. To make matters worse, I have to enter orders on abnormal results twice, both on paper and electronically, which means that my nurse's work is duplicated, too. I can't just enter orders on one copy — since no one knows, with this EMR, which will actually make it into the system. Sound overcomplicated? Sound pricey?

Note to prospective EMR buyers out there: it won't save you money, it won't save you time, it won't reduce your stress, it will only give you a new set of problems that become amplified with each new glitch. (This includes the minor glitches, when the system crashes and you're behind half an hour and it takes fifteen minutes for the system to come back online again, and the major glitches, when the system locks you out and needs to be resuscitated by the computer people over the course of a week and things revert to blessed paper anyway.) We've had this system since last spring, and new disasters keep happening. Some days I feel like firing the whole works out the window.

I don't, though. It cost $100 000. And that's the irony: we're in too deep to ever go back.

— Dr. Ursus