I continue to find twitter a great place to have professional conversations (that’s right I said twitter). Yes I spend too much time there but still there is great value in the platform. It’s just formal enough to be be able to organize communities and conversations with hashtags but also informal enough to these conversations genuine. Mark Friedbergs’conversation about electronic health records is a great example.
My organization went live with an electronic health record about a year and half ago and it has certainly been challenge. Electronic health records are ripe for opportunities but as Mark points out they often fail us as providers and our patients..
We need better #EHRs. But it’s hard to solve safety & usability problems that stay secret.
Post your #EHRbuglist
Here’s mine pic.twitter.com/Lt6WzzcQa2— Mark Friedberg (@MWFriedberg) June 1, 2018
Hard to read the tiny print but he mentions things like providers being able to have more then one patient open at the same time when busy and also needless alerts. Since getting a bit more active in the Health IT community, people have strong opinions about EHR’s. I started to look more at the hashtag but it transitioned from a gripe session (for you Seinfeld fans it felt a bit like the Festivus “airing of the grievances”). The more I read into what people had to say the more it had real value that could drive solutions…
Here's mine. The most consistently annoying things for me are inconsistencies that lead to an increase in cognitive load. #EHRbuglist pic.twitter.com/YkfvmeXZ8V
— Jeff Linder (@jeffreylinder) June 1, 2018
One more: to accommodate the overloaded display, our clinic had to purchase huge new monitors. So huge that about a half dozen of my patients have bonked their heads on them.
Challenge for #EHR developers: de-clutter the display enough to make it fit on a tablet.#EHRbuglist— Mark Friedberg (@MWFriedberg) June 1, 2018
Hi @MWFriedberg! here's my #EHRbuglist:
1. An EHR that doesn't have a hard stop for prescribing drugs a patient has a listed allergy to – IT said the company "doesn't want to be held responsible" – true story. (I don't use that EHR anymore…)— Audrey Provenzano (@audreymdmph) June 1, 2018
5. I can't trend vitals for more than the 3 last visits! or weights! #EHRbuglist
— Audrey Provenzano (@audreymdmph) June 1, 2018
It's really difficult to maintain situational awareness of a busy Emergency department using the Epic track board. Hard to know who's where, what's done, what's missing, who's sick, who's not. The track board is too big for the screen. Can't remove columns. #EHRbuglist
— Shannon McNamara, MD (@ShannonOMac) June 2, 2018
My complaint has definitely been around usability and thankfully not too patient safety issues. After I have finalized a progress note, the only thing I can edit is the date… and that’s it. If I omit something or make a mistake I have to go back and redo the entire thing. Also there is no way to delete the original note with the mistake. It often becomes highly confusing. Also as you continue to addend treatment plans there I no way to note why your are continuing or discontinuing a goal or changing an objective. It makes it very difficult to tell the story of progress or lack thereof.
However being the good social worker I am I also wanted to highlight solutions. Think this is they value of a lot of conversations on social media. As much as we envision arguments being that the center of social media (especially in this political climate) it can be a place to find solutions as well…
Patients have an #EHRbuglist too. I think doctors and patients can agree that things need to change asap and better EHRs will only happen with doctors and patients as part of the design team. https://t.co/D7H4Zho4Rj
— Erin Gilmer (@GilmerHealthLaw) June 1, 2018
7. I don't want to spend this whole thread complaining. EHRs are wonderful overall & I am so appreciative to get to use one- just hoping for improvements to make all the info easier to digest & software more intuitive to use. Thank you @MWFriedberg for leading this! #EHRbuglist
— Audrey Provenzano (@audreymdmph) June 1, 2018
Similar to multi-disciplinary conversations on media, we need these “in real life”. My solution is that Health IT departments and providers develop discussions about usability; develop work groups and try to better understand each others work. You may have a idea to improve somethings but their may be a barrier on their end. You don’t know until you come to a deeper understanding. As Dalton Ruer suggested in his recent post about solutions to physician burnout and suicide…
“They actually had the nerve to suggest that healthcare IT workers get out of their padded office chairs and walk on rounds with clinicians.
The horror of it. Actually having to walk with physicians and watch them in action. I mean it’s not like they do this on a daily basis so how in the world would your schedule ever possibly line up to make that happen? Seriously it’s not like this topic is important enough that YOU need to take action. Is it?”
This is not a difficult notion to grasp but team based collaboration can solve a lot of problems. A few months ago I was listening to Sirius XM Business radio (a bit of a junkie). I forget who the guest was but they were talking about how in a lot of organizations Chief Financial Officers and Chief Human Resource Officers don’t always converse or collaborate. Despite their overlap these two department heads often exist in silo’s. Thinking from the systems perspective it would make sense that these departments should “talk” more and work on collaborative projects. They cited examples of this increasing efficiency and production in both departments.
Thinking from the systems perspective the clinical and Health IT roles have are similar. Although two different area’s of expertise, they are attempting to solve the same problem. The exact problems outlined in the #EHRbugList. Creating a record that it both meaningful to patients, providers, and regulators. Also keeping in mind that patient safety is paramount and it makes sense for the encounter.
To take a deeper look in to the list I have curated them here in this Wakelet story (feel free to click on the picture for the link. Also stop by twitter and add your own to the item to the buglist. Clinicians and Health IT staff can work together to solve these problems.
