The Great DOS Crash of 2014
I was recently browsing popular physician blog KevinMD when I noticed a post titled "Paper Charts Never Crash". Barf. Admittedly, I didn't read the article but it ignited my fury over the resistance to technology in medicine. Rather than embracing the cool, innovative products and systems brainy techies are bringing us, we over analyze and over regulate accepting the mediocre. It's 2014 people, get with the program.
Just like my grandmother resisted getting AOL back in the 90's and my mom stuck to the stack of encyclopedias rather than switching to Encarta, doctors and administrators are putting the brakes on innovation in healthcare. Have I mentioned before that my hospital's computer charting system runs in DOS? I case you can't remember what DOS is because you were wearing diapers when it came out, think pixelated green block letters. Well, last night at work the DOS system crashed (shocking) leaving me high and dry back in the fast track.
When our DOS-based EMR crashes, we go back to good 'ole pen and paper because unless there's a fire, or someone spills their Diet Coke, or a pregnant lady vomits or a drunk patient decides to urinate on the counter, paper charts never crash. While working in DOS on a daily basis sucks (although it does conjure fond memories of playing Oregon Trail in the elementary school computer lab), paper charts totally suck. Let me give you a glimpse of the process.
First, the patient shows up in the waiting room and the waiting room coordinator yells over her shoulder at the triage nurse to stop reading her Kindle, a patient has arrived. Then, the triage nurse fills out a 20 something page packet including the patient's vital signs, medical history etc. Next, the patient is escorted back to a room in the emergency department. I pick up the chart and proceed to re-ask all of the triage nurse's questions because I can't read her handwriting.
When it's time to write orders, I get out one of those carbon copy sheets, you know the ones with a white sheet followed by yellow and a pink like they give you at Jiffy Lube when you get your oil changed and write down my orders. Then, the patient's nurse tracks me down because I scrawled down my orders too quickly and she can't tell if the "X" is next to the strep test line or the flu test line. "Flu test" I say.
A bit frazzled because I can't actually tell when labs and imaging orders have been completed, I incessantly call the lab asking how much longer until the flu test is complete. "We will fax you the results when it's ready" the lab tech sighs. Perfect. I love getting faxes. I tell her I will deliver the next flu swab to her desk by carrier pigeon. Then, I remind myself this situation is not her fault and apologize.
30 minutes later, someone drops a stack of faxed lab results on my desk. I sort through them making sure there are no critical values that need to be addressed. I am documenting like crazy on my paper charts since I know most of this stack of paper lab results will probably be lost and won't end up in the patient's record. This is obviously the foundation of any good legal case.
All I could think about during this entire down-time endeavor was a) how many glasses of wine I was going to drink after work (the disappointing answer- none, I was too tired) and how I couldn't believe the whole emergency department used to operate in this manner. Perhaps this system crash was designed by the hospital IT department so I would stop making fun of DOS. Well it worked. For this weekend, anyway.
The moral of this story is that we need to implement the best when it comes to technology in medicine (DOS is not the best...). Whether it's embracing telemedicine rather than being a naysayer, encouraging your patients to use patient-provider texting apps or simply demanding an EMR that's up to date, it's time to stop dragging our heels and give technology a chance.