(Ed Harris as Gene Kranz in Apollo 13)
A lovely bit of fun as I was getting ready for work last night. I received a text message from my boss (ya know, since “sane” people are long gone by the time I roll into work) saying that we were issued laptops for greater portability starting next week. I was thrilled because of the portability and the fact that my machine would essentially be unmolested by any other users (except the IT guy, and we know about their microchip fetish). There is one caveat (oh shit… don’t say it), they removed the desktops today and replaced all the computers with docking stations for the laptops…UGH! Yep, a workroom without a computer.
We see too many memes on the internet that show that serene picture of a cabin in the woods and the line, “You get 10 million dollars, but you have to live here with no internet for a year.” While many folks here in the west seem to think they have that mentality, it would be nearly impossible. If you don’t believe me, look around at other drivers when you are out and observe how many of them have their heads buried in a cellphone. I ride a motorcycle (I know weird for someone in the medical profession). One day on the bike, a friend of mine and I on a ride saw no less than 30 cars at stoplights on the phone. Even a few moving where the driver had their head buried in a cell phone (and people still bitch when they try to pass legislation preventing your car from being a rolling phone booth).
In my practice, I see a great many people whose internet access is their telephone. Gone are the days of desktop or laptop ownership; we have a phone for that. I must tailor my comments to looking up resources on a mobile web browser. Hey, it’s workable, and most folks don’t need the computing power that a desktop or laptop gives them, and honestly, daily handheld devices are just fine.
Until you need the computing power. While I did use the technology of that log cabin in the woods when I began my nursing career (Paper charting for hours and hours ad infinitum), we started using EMRs about five years into my career. Back in those days, orders were faxed to the pharmacy or sent through a pneumatic tube system in the hospital that we used to send things more rapidly (or rabidly) than by a runner. We sent labs through the pneumatic tube system. Then came the computer. Initially, in our hospital, we just made chart notes in the EMR, and orders went in separately still. Then…everything.
Now, you are powerless without computer access, especially as a provider. I have to order tests, procedures, medications, and even nursing text orders all through a computer. All this sounds like hell to technophobes, but I have had to use the “paper” system in the hospital in emergency network failures, and it is stunningly difficult and slow. It is very prone to error since most EMR’s auto-check medications and orders to ensure there are no conflicting medications. In the EMR, I have to use two-factor authorization to sign prescriptions that go to the hospital pharmacy. I know; it kinda reads like stereo instructions. The nice part is that without that second factor, I theoretically can’t be “spoofed.” I still don’t want to push that.
I remember the “glory days” of paper charting and how it was like pulling teeth to get some old school, old warhorse nurses to do it.
So fast forward a week (since I hit writer’s block and never finished this…I can see you are shocked), and now for fun, the servers go down nationwide (kinda like Igor did and probably just as badly). So, we go back to the early 2000s and do everything on paper. Of course, a huge mess is a bitch (also like Igor) doing double documentation anyway. When I say double documentation, I mean you still end up manually entering that note into the EMR, and all orders have to be in and reflect that.
Finally, have the laptop complete with its dock and monitors set up and got to thinking about the EMR and all the pearl-clutching and bitching that it has caused in “old school” practitioners. Don’t believe me?
In my last term in school, on my family health rotation, I had a preceptor, let’s call him Cosmo. Cosmo was a “right” Utah person who used to espouse on the Obama’s, causing all the problems by using electronic charting. Of course, he also hated the ACA, shocked, I tell you.
The ACA or Obamacare (because we had to name that everyone could “get enraged at for quality healthcare). From the language of the law:
As a part of the American Recovery and Reinvestment Act, all public and private healthcare providers and other eligible professionals (EP) were required to adopt and demonstrate “meaningful use” of electronic medical records (EMR) by January 1, 2014, in order to maintain their existing Medicaid and Medicare payments.
Well, there you have it, so why was Cosmo all freaked out about this? In the almost three months I was there, I didn’t want to engage him too much on his dislike for Obamacare because here in Utah, that takes you further down the stairs to that crazy basement with ten levels of even more crazy levels below that. However, I did manage to get out of Cosmo at one point that he was tired of all the trouble that “being required” to switch to an EMR was such a headache for the practice.
Well…since the practice was almost four years behind the ACA mandate… See, a lot of folks here in Utah kept hoping that the courts would strike down the ACA in its entirety because who wants “Obama in your practice,” as Cosmo always said.
As I said, I have been using an EMR now for shy of 20 years, and honestly, I do not see the downside. The portability and access to other’ facilities medical records in a hot minute can be incredibly beneficial in treating a chronic condition. In our system, we can use a viewer that allows us to see any record generated in the system nationwide and anything from the DoD. It is convenient for folks who are mobile their whole lives and have visited different facilities. But, in the spirit of honoring the opposing argument, here are some answers to the biggest complaints. Here they are in no particular order:
“This is another way for the government to spy on me” oh, FFS, really? Comments like this are usually said to me while “coming up for air” buried in your cellphone. The “government” has more info on you from that handheld device than anything else. Remember when you were talking to your friend about that burning rash “down there?” Yeah, they know that now too. All insurance companies maintain a record of your health issues. These include what they have been billed for and have paid for. I worked for an STD clinic, and even though it was a “free clinic,” there was still a record, even if it was by number. The information is out there, and even before electronic access was there, there were always people in small towns that would blab about your condition.
“Obama is trying to ruin my practice.” Seriously? While waiting for and hoping that somehow this portion of the law would be struck down, you could have just started an easy more cost-effective transition. Instead, you chose the jump out your ass at the last-minute method, which of course, is far more expensive. Where I was at, the biggest problem was secure networking. Seriously, again? Everyone in this office lived on their computer or phone. It is beyond crazy to think that as “afraid” as you are of “big brother,” you would just willy nilly use any network for your data. Then again, you do not know what data security really is, now do you? I am on a secure home network. I have several software systems running that stop or warn me from using sites known to contain malicious code (that’s the stuff that can get in your computer and give someone access to the real important information…like your grandma’s cookie recipes). Hell, the EMR I maintain at home for my consulting work (Open EMR if you must know) is kept on a virtual machine inside this computer. If you don’t know what a virtual machine is, it is essentially another computer that software creates inside your physical computer. It has separate network addresses and, oh shit, stereo instructions again. In a sense, it is hiding the machine inside the machine for protection, and if it is messed up, it can be re-created. If you are an IT geek, I know this is an oversimplification, but hey, we need to get this Technics stereo up and running so we can listen to those 8-tracks, so hang on. The bottom line, stop being cheap and waiting; just do shit.
The use of technology in and of itself is the one complaint that always seems to drive this train the most. “It will take too much time; I can’t type fast. Geez, dude, seriously, can you even set the clock on your VCR? (for the younger folks reading, go ask your mom, I’ll wait….I usually don’t have to wait for your mom, but I digest). Dude, I have a template for everything, and I use Dragon naturally speaking, medical edition. Shit, I can do notes in about a 1/8th of the time it took me to write that shit out, even on a premade form.
Look, it all comes down to change. We hate the Paris climate accord and shutting down a pipeline that transports fracked oil because of a few people losing jobs by making an industry obsolete. We hated robots on assembly lines for the same reason. A friend’s dad, an autoworker, went to school during a strike and at night to become certified on setup, repair, and troubleshooting of said robots. Yep, he adapted to the change and ended up making more money because he was forward-thinking. It’s just like the whole coal miner thing. Look, folks, we have cleaner and cheaper energy sources than coal. It’s dying, get over it and adapt. Same with your damn paper charting; get over it and adapt.
It’s the cycle of life. Now go ahead and press the power button on your stereo and insert the eight-track tape and you should hear the music in Hi-Fidelity (your dad can help you with the meaning there).
Be the kind of person your dog and your mom hope you are.