The other day I ordered a CT scan with contrast on a patient with an apparent mass on his neck. I explained about the need to get a blood test to make sure his kidneys could handle the iodine contrast. Because our lab was closed, I had to print a requisition for him to bring to the hospital lab.
Printing a requisition from our EMR is a multi-step process that involves leaving the “superbill” (I don’t know what’s so superior about it, but that’s a different topic), going to “chart,” clicking on “requisitions,” highlighting the “creatinine” I just ordered, selecting “in-house lab” even though the requisition is meant to bring to the hospital, selecting “OK,” then getting transported to another screen where I must again highlight “creatinine,“ clicking “print,” getting to a pop-up window that says “could not find a printer,” clicking on the name of the only printer on the network I ever use (immediately to the left of my desk back in my office), clicking “OKok” and walking down the hall to get the piece of paper, signing it by hand even though it says “electronically signed” and (finally) giving it to the patient.
The next day we got a fax from the x-ray department with their premedication protocol for iodine allergic patients. I had missed the fact that my patient had an allergy to iodine.
I simply missed the fact that my patient had this allergy, and he didn’t catch my comment about “iodine contrast.” I should have asked more specifically about iodine allergy, and I should have made the detour from “superbill” to “medications” to “allergies” before going to “chart” to go through the steps of ordering the creatinine, but this time I didn’t.
My million dollar system, which doesn’t even have a spell checker, doesn’t know that a CT with contrast requires a creatinine and is contraindicated if the patient is allergic to iodine. It makes me follow a workflow that reminds me of my high school introduction, in the early seventies, to the early programming languages of the day (COBOL and Fortran, if I remember correctly) and my first Atari home computer. It is far removed from the $500 iPhone I carry on my belt.
In the days before our EMR, filling out a paper requisition took only a few seconds and gave me more time and mental space to chat with the patient about the test itself while I was completing the task. With the archaic workflows of my EMR, my attention is drawn away from the clinical scenario to the not-so-smart computer in the room.
What was supposed to make the practice of medicine safer and more efficient is, to date, only a gleam in the eye of software designers, politicians, and clinic administrators. For those of us in the trenches, it is at least some of the time just a bunch of extra work with very uncertain benefits.
“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.