Saturday, April 2, 2011

EMR Follies

Soon I will write a more definitive blog on the shortcomings (and there are many) of the electronic medical record (EMR). I am working at my clinical job this weekend. I couldn’t resist sharing this with you. At my hospital, the dictation system is great. Dictations of the history and physical (H&P) examination usually appear in the EMR within an hour or so of their dictation. When the physician logs in, he sees a list of documents to be verified with his electronic signature.

I was asked to consult on a patient on the internal medicine service today. Below is a screen capture of the list of her medications in the dictated H&P. The H&P had been verified by the doctor who dictated it. If you can overlook the fact that the patient was on 22 different meds (not a record for patient on the medicine service, by the way), check out #13 on the list.

Yes, it is the wonder drug _ _ _ _ _. So what happened? For whatever reason, the doctor obviously did not read his lengthy H&P. (Remember, it was a medical patient.) He signed off on it without a glance. Should I ignore this and go ahead with surgery on the patient? What if the drug was Coumadin, an anticoagulant, which is often given in a dose of 5 mg?

What's that you say? Ask the patient? Well, like many patients, she has no idea what medications she is taking. The list was brought in by a relative and is nowhere to be found. Ask the doctor who did the H&P? No, sorry. It's a hospitalist service and she was admitted two days ago. The doctor is off this weekend. Via a blood test, I was able to determine that it was not Coumadin.

Stay tuned for more examples of EMR follies.


webhill said...

what the hell is wrong with this person? a hypertensive, menopausal woman with history of stroke, chronic pain, fibromyalgia, depression, anxiety, and some kind of infection?? WTF?

Skeptical Scalpel said...

Everything you mentioned plus lupus and osteomyelitis. She's a sweet lady with lots of serious problems.

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Anonymous said...

Vancomycin 250mg daily????? Huh???

Skeptical Scalpel said...

Yes, that's a good question.

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