One More Thing on EMR Flaws, Dangers: Why Patients First?

The Daily Apple™© Volume 2, Number 9
August 29, 2013

Technology Failed Again.  That reminds me to remind you about the need for redundancy, when it comes to HIT stuff.

When thinking about EMR<>EHR<>HIT stuff and designing better HIT systems ... remember this.
Wall street went down on (Thursday, August 22, 2013)

  http://dealbook.nytimes.com/2013/08/22/nasdaq-market-halts-trading/?nl=todaysheadlines&emc=edit_th_20130823&_r=0

but, nothing happened.  A few guys made less money?  There was a delay in trading ... so what?  Who cares?  If I were one of those trader guys, I would have hiked out of the office, grabbed a cup of coffee, walked down to the river, felt the sunshine and watched the water run by.  "Call me when things are back up and running."  But, in my business, I can't do that.

There are few things in life during which time is critical.  In fact, time is usually irrelevant.  But, in the spectrum of life, health, healthcare and death, the natural history of injuries and diseases dictate some of the critical moments in life.  So, chill when you can ... drink the coffee and smell the roses.  And, recognize those things that require immediate attention ... true emergencies.

In other words, there are certain illnesses and injuries during which minutes ... even seconds of delay in proper diagnosis and definitive treatment may result in permanent cell damage, organ damage, loss of limb, or loss of life.  The diagnosis and treatment of these conditions is CRITICAL CARE ... That's my day job.  In this business, there is no excuse or time for "systems down".  In other words, we have to be ready to take care of these sorts of problems 24 x 7 with or without technology.  That is the simple truth.  Veritas!

During Katrina, ALL SYSTEMS WERE DOWN within a few hours and they stayed down for days to weeks.  In the immediate aftermath of Katrina, we had NO RECORDS on many patients, some of whom were critically ill.  Direct care Patient<>Physician<>Provider prevented many disasters in our hands.

Intermittently, every electronic record and system I have used has failed.

Intermittently, every piece of technology I have ever used has failed.

Conclusion:  There is no such thing as failsafe.  But, we can build redundancy into EMR<>EHR<>HIT Systems that will generate smart cards and "hard copy" intermittently, at a frequency to be dictated by the "situation" the patient happens to be in at the moment.  If "the patient" is in the hospital, or the Intensive Care Unit, hard copy of the EMR/flow sheet should be printed out at least every 8 - 12 hours. At the push of a button, the "system" should generate a smart card and paper summary for each patient.  In critical situations, attach that summary and smart card with all essential data, at least a problem list, to name tag that hangs on the patient's neck.  That way, the patients and the folks on the front lines with the patients who are responsible for their care will have a little something to help them get some background information.  And, the folks who receive them will also have something to go on.  Add this capacity to the design of any robust EMR<>EHR<>HIT System.  Just my opinion.

And, HIT guys ... don't look at me as if I have two heads when I tell you these things.  Fix it!

Dr. Mike
Michael F. Mascia, MD, MPH

Mission: Healing November 2, 2011

PGY 39, Day 124
For FAMILIES of Patients In the Intensive Care Unit

Here are a few pointers based upon my observations while caring for patients in the ICU over the years.
First, For Families and Loved Ones
StepWisely(R)
Improve Quality First = IQ First(TM)= Best Outcome = Best Care = Most Cost Effective Care = Best Practices

The First Ten Steps to Rational Cost Containment(TM) (RCC)

For Families of Patients In the Intensive Care Unit
1. Trusted Doctor: You must have Faith and Confidence in the physician(s) who take care of your family member, friend, or significant other. If you do not trust the people you are dealing with, arrange for a transfer of care to another facility, or doctor, or both.
2. CARRY OUT THE WISHES OF THE PATIENT: Make sure you have advanced directives that are based upon the wishes of the PATIENT, not your wishes, or the wishes of another family member. Do not impose your beliefs upon the patient. Do the RIGHT THING for the patient.
3. TEAMWORK: You are a member of the team. Find out how you can help. Ask what you can do to help. It is NOT HELPFUL for you to interfere in the care of the patient by spending too much time at the bedside. Ask the Doctor and the Bedside Nurse, what you can do to help when you are at the bedside.
4. Take Care of Yourself. You can't help if you are exhausted or in the way. Get some sleep. Identify your preference (if any) for religion and religious support. When the situation is critical get these folks involved.
5. Designate one or two members of the Family who are the primary representatives and spokespeople for the family. You will be responsible to coordinate information sharing with Family and Friends
6. Do not disrupt care: It is not helpful to have any DRAMA at the bedside
7. Write down your questions and the names of the people who are members of the care team
8. Make sure you understand the care plan
9. Review the care plan with the Critical Care Team Every Day and whenever changes are made
10. CONTACT INFORMATION: Give your contact information and GET the contact information for your care team.

Let me know if you want me to elaborate on any of this. Next will come a piece for PROVIDERS and I promised some guidance regarding influenza.

Questions or comments, contact me.
Dr. Mike