Monday, April 2, 2012

Medicine Without Charts

Our hospital has been using electronic medical records for over a month now and in general most people have adapted well to it. Still it is shocking to open a patient's plastic binder and find almost nothing is inside that can be considered a chart. Sure all the progress notes now are legible since everything has to be typed in. There is less chance of an order mix up because there are all sorts of electronic nanny barriers that prevent you from giving something like penicillin if the patient gets anaphylactic reactions to penicillin.

But that doesn't mean all is hunky dory. Maybe it is just our particular system, but I find it harder to find the information I want these days. Before, I could scan through a chart to find the note I'm looking for. I can skip through the pages of social worker and nutritionist notes to find the ones written by the cardiologist or the nephrologist, since those are labeled at the top of their notes "Cardiology" or "Renal". Now when I click on the Notes section in the EMR, I get pages of notes that have been written into the computer by everybody who has been taking care of the patient, including nurses, respiratory therapy, and other ancillary services. While I can focus down to just physician notes, they are not labeled by the type of physician, just their names. Therefore, unless I know the specialties of all the doctors in the hospital, it is very hard to find the pulmonologist's note or the ID doctor's note. All I have a bunch of doctors' names.

That's what I miss since moving to an EMR, the ability to quickly scan through a chart to find the information I need. Most doctors know that daily progress notes in general don't have much new information so they can be quickly skipped to the ones that truly hold new relevant details. With the new system, it is impossible to do this. I have to click on every single progress note and hope something important is written on it. In fact I've missed important information on a patient because in preop I don't have the time to open every progress note on a patient that may have been in the hospital a month or longer. The surgical procedure note that details the patient's recent abdominal surgery may be three pages down on the list of physician notes. The cardiologist's interpretation of a patient's echocardiogram may be lost in the vast trove of information that doesn't distinguish between what's important and what's filler.

We're all still learning the system so I'm hopeful that these frustrations will eventually be ironed out. The amount of customization available to a doctor is mind boggling so there must be a way to get to the things I need without so much fuss. At least I'm keeping my fingers crossed and hoping for the best. In the meantime I still have to do the maddening pattern of clicking open each freaking progress note one by one and hope there is more information there than the patient's morning vital signs.


  1. What is the name of your system? Do you have computerized charting in the OR?

  2. I am not going to mention the name of our EMR system. However let's just say they are one of the largest vendors of EMR's to large medical centers in the country. We don't have electronic anesthesia records yet. That is supposedly coming down the line in the next couple of years. The aggravation never ends.

  3. I think that once you have a completely electronic system in which all patient info is available both inside and outside the OR, you will wonder how you lived without it. Are you referring to electronic charting as aggravating or just the process of switching over? Computer charting rocks!