Perhaps my technical breakthrough will seem like a small matter to you, but between patient appointments I couldn’t restrain myself from bragging to the nurse that I had managed a paperless document transfer from the hospital electronic medical record to the office EMR.
This geeky accomplishment had eluded me for months. When our office converted to an EMR system, I asked the vendor how outside reports would get into the EMR. Don’t worry – I was reassured that the data would automatically "populate" our EMR. That promise never came true. Our office lab computer system is integrated, so our own lab results appear in our system as soon as a test is completed, but all outside results require a paper document that has to be scanned into our EMR.
My office has had EMR for about 6 years, so this is an old issue, but the latest source of frustration was the hospital’s transition to the Epic software for medical records in February 2011. Chatting with a clinic nurse from the hospital, I learned that she has been using the system in the clinic for 3 years, and she got to like it. For me, it has been an epic struggle to learn, and I can only hope to master the new system before my retirement decades hence.
My gripe isn’t with the hospital EMR or my office EMR, but the fact that the two systems do not communicate with one another. If one of my patients is discharged from the hospital, the hospital mails my office a paper discharge summary, my office scans it into our system, and then we shred the paper document.
Each nursing station in our office has its own shredding collection box. Every week, a man empties these containers into huge drawstring laundry sacks and puts them on a large flatbed dolly to haul them to his truck.
I mistook the recycling man for the dry cleaner, and he seemed wounded by my faux pas. I made some sort of awkward apology, and he went on to explain that the type of paper our office shreds was suitable for recycling into low-end paper plates. I feigned some interest in the paper plate aspect of his talk, and he seemed a little mollified that I had assumed he was the dry cleaner. I’ve never met the dry cleaner, but I wondered if the converse holds true: Would the dry cleaner be equally offended if mistaken for the recycling collector? It’s hard to keep everybody happy in a busy office.
Transferring information from one EMR system to another is a problem that comes up frequently. Patients come to the office and tell me that they’ve had labs or x-rays done at the hospital. I’ve become proficient at retrieving the information I need, but even so, it is not a fast process. I frequently describe this process out loud for my patient audience so they don’t think I’m really just checking e-mail while I pretend to be reviewing their records.
Here’s how I describe it to my patients: First, I have to enter my top-secret password. Then I have to click on the link for the EMR. Then I reach a screen with an outer-space picture emblazoned by the announcement "leaping to hyperspace." (I have often suspected that the EMR designers are old Star Trek fans.) After I make it safely into hyperspace, I have to enter my secret password a second time, type in the patient’s name, retrieve the chart, and find the relevant information. This takes at least 3-5 minutes. That might not sound like a lot, but it adds up over the course of a day, especially if the typical patient visit is only scheduled for 15 minutes.
I was trying to talk myself and my patient through the sign-in challenge recently when I hit a speed bump: The computer demanded that it was time for me to change my password to protect the security of the system from alien invasion. I tried several different new passwords, but the system was in a picky mood that day and rejected one prospective password after another until I finally succeeded. Just as I had hacked – I mean, signed – my way in, I heard a small voice behind me. I had all but forgotten that I had parked an 84-year-old woman with severe low back pain on the exam room table. She just wanted to let me know that she couldn’t sit unsupported on the table any longer, and she slowly got up and walked back to her chair.