Sunday, April 29, 2012

Thinning The Herd

You could call it Darwinism by EMR. In my ongoing reports on our hospital's conversion to all electronic medical records, I've mentioned some of the difficulties of adjusting to this 21st century reality. There has been much frustration and hair pulling by all as the seemingly mundane tasks of writing notes and orders on a paper chart are transformed into time-consuming chore that a few months out still require handholding by a team of software support people who roam our hallways.

Now comes word from our Chief of Staff that several doctors have had enough of this. In a recent email, he noted that a couple of dozen doctors have resigned or downgraded their status with the hospital. The ones who remain have either chosen to do consulting work only, thereby eliminating the hassle of entering computerized orders, or retired to "Emeritus" status, which pretty much is the same as resigning while still maintaining a link to the medical center (free parking in the doctor's parking lot and free breakfast with free newspapers in the lounge).

Most of the physicians who resigned were ones who were close to retiring anyways. They had few patients in the hospital and didn't have very active practices. The EMR was just the final straw for these guys, most of whom went to medical school in the 1960's and 1970's. Many didn't know how to type, much less use a computer mouse. It must have been infinitely aggravating for them to try to enter an order for "Accucheck" to measure a patient's glucose level and have the computer reject the order because it could not identify it. The doctor would have to know that the order is actually listed under "Glucometer". Grrr. It's a wonder more doctors haven't resigned by now because of this craziness.

How are the older anesthesiologists holding up in our group? I've mentioned in the past about how rusty some of my colleagues are in performing some basic anesthesia skills. But so far they are all using the EMR quite well. Maybe it's because we have so many support people hovering around the preop and postop areas to assist them. Perhaps it's because anesthesiologists have very simple documentation requirements. Most of our paperwork is easily converted to templates that are quickly filled out with a few clicks of the mouse. So our department has been spared the angst suffered by our internist and surgical colleagues during these trying times. We'll have to see what happens when our operating rooms finally converts to electronic anesthesia records, which is promised in a couple of years. The thinning of the herd will continue unabated.

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