In the transition to a computer based patient records system, picture the following:
The nurse’s station is in an enclosed room with computer keyboards and monitors. Technicians and aids (not nurses) travel back and forth between the patients and the nurse’s station to report what is going on with the patients. The nurses dutifully type in the data, no time left for them to actually lay eyes on the patients they are supposed to be caring for. Any systems analyst worth his salt already sees a “lost in translation” issue with this setup, an intermediary between the source of data (patient) and the individual acting on it (nurse).
A patient appears on the floor from the emergency room. The emergency room clerk and nurse “entered him in to the system” when he got to the hospital. He was taken to the floor by an orderly and left in the hall. The nurse tech approached him and asked him his name. She then went to the nurse’s station and told the nurse about the patient. He couldn’t be found in the system. As far as the nursing station’s computer was concerned, he didn’t exist. He was invisible. The nurses weren’t sure what to do with him. Whatever his diagnosis made by the emergency room physician, the nurses didn’t know. Since no written orders or nursing notes were available (all on the emergency room computer) they couldn’t do anything with him….had no idea what was wrong with him or what to do about it.
They finally fed him.
The above is unfortunately true. This happened at a local hospital here in Oklahoma City. This hospital, like others, has begun or completed the transition to a computerized patient record system, a paperless system….known to readers of this blog as an electronic medical records system. There has been no market for this business, so the federal government essentially forced these hospitals (and physicians who accept federal money) to convert to these systems or face penalties, the most significant of which is lower Medicare reimbursement for non-compliance. One can only wonder how much money made its way to D.C. from companies that stood to benefit from this leverage, for no one would have done this on their own. To sweeten the pie, the government (you and I since they have no money) paid for about a third of this expenditure. A carrot (bribe from the feds) and a stick (pay you less if you don’t take the bribe). Ahh…business the D.C. way. And we all wonder why health care is so expensive? And the result? Patients without nursing contact and invisible to “the system.”
G. Keith Smith, M.D.
