Saturday, September 22, 2007

A suggestion to the medical community...

If I could change just one thing about the medical establishment in the United States....and believe me, there is a lot more than just one thing I would would be our system of record-keeping. It's outrageous. Just about every hospital has their own informatics system, each with their own bewildering array of buttons and commands in order to accomplish just about the same thing. Once a physician stays at the same hospital for a period of time, they can obviously learn to master the system and use it efficiently. However, a physician working at multiple hospitals (which is more and more often the case these days) will have to contend with multiple computer systems. The even bigger problem than physician convenience, however, is the difficulty in communication between hospitals. It's sometimes nearly impossible to figure out exactly what happened to a patient when they are hospitalized at a different hospital, even with faxed records--a large inconvenience even in the best of situations--this involves having the patient sign a release form, calling the other hospital's records department, faxing them the form, hoping that the records person is going to take the job seriously, and then hoping the relevant information makes its way over.

In my mind, this could largely be fixed in one fell swoop: do what the VA Health System does. Every hospital in the U.S. should be required to use the same interconnected health information system. This is how it works at the VA. They developed a computer system in the early 90s which despite its sometimes archaic features, is surprisingly versatile and extremely reliable. Every single thing that happens to a patient in the health system--from cardiac catheterizations to rehab stays to nursing homes to visits with the hospital chaplain, even--goes into that computer system. Having this degree of detail available would, in my opinion, be the single-best thing our health system could do in order to improve patient health care. I also suspect that it would in the long run save money, as it would probably cut down on redundant tests that are performed.

Other news: our camera is on the fritz so unfortunately there may be a lull in Sophie photos . Here are some from the archives.

Time to start bundling up for the cooler fall weather.
Still smiling a lot!

Sophie's mobile kind of reminds of either the scary "Feed Me, Seymour" plant from Little Shop of Horrors or something out of the "Alien" movie series. Hopefully she won't be traumatized by it...


Blogger Eric said...

What are your thoughts on the Latin abbreviation system (tid, bid, etc.)

I have heard some doctors are now trained to just say, "twice a day" as the system has become largely digital and brevity is not as much an issue.

We have to teach this system to staff in group homes - many of which have no more than a HS education. Then we hope that over the years they don't forget that training and mess up a psychotropic med. I've been lobbying for a reduced paperwork system for our field. We currently have every staff write a "Daily Log Note", which can range from three poorly constructed sentences to a full page of useless information. My personal favorite "A.B.'s malaise persisted throughout the evening, infecting others in his presence, and bringing a cloud down on an otherwise splendid evening".

I'd rather see a checklist with a spot for notes. Ask 15 important questions, allow the part-time poets an outlet as well.

We're just breaking into the digital world, though it will be a long time before we are integrated into pharmacies and clinics.

Well, it's HS.


8:07 PM  
Blogger nathanhellman said...

Interesting comments.

I have to say that as a doctor I like the current Latin abbreviation system. There's still a lot of writing involved in the job and writing "q.d." instead of "daily" is simply faster.

The controversy these days is that doctors are now being regulated for their legendary messy handwriting. There have been instances where a "q.o.d." (every other day) was misinterpreted as a "q.d.", for instance, and now the official hospital policy is that we write out "daily" instead of using the abbreviations. I personally disagree with the rule: if you have neat handwriting, you should be able to use the abbreviations.

But I think a lot of these issues would be solved by moving to computer-based ordering systems, which is fortunately the trend. The point I was trying to make in my last blog entry is that there is no standardization or communication between hospitals regarding the computer systems that are being used.

I am currently working within the "Partners" health care system which comprises the two major Harvard teaching hospitals, Brigham and Women's Hospital and Massachusetts General Hospital. Even though they are supposed to be within the same "system", each hospital has about 3-4 computer systems apiece which are essential for patient care, and are really different from one another. I don't understand why they don't just all convert to the same system.

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