This past weekend, I had to accompany a relative to the emergency room of my local hospital. She had been feeling poorly and the doctor on call (hers was off for the weekend) suggested she needed to get checked out and get a blood test.
When we arrived, the check-in area had her complete some forms and entered her into the system. She has been to the hospital before, so her medical and insurance information was already there. Then we sat and waited; actually it wasn’t very long.
We went into the triage area where a nurse took her vitals, asked her what was wrong and copied down everything about her medications; she brought all the prescription bottles to make this easier. The nurse wrote some of this down on a form and entered some of it into the computer. After that, we went out to the waiting room and waited.
A little while later an orderly (do they still call them that?) called her into the examining area. We went into a room and waited. Another nurse came in and asked all the same questions the triage nurse asked. I never know if this is to verify things or inefficiency. As the nurse asked and got answers to questions, she entered them into a computer in the examining room. She again asked about prescriptions and jotted them down on another paper form.
At this point I was thinking, “What’s the point of putting all this information into the computer, if multiple people keep asking the same questions? And why are 2 people writing things down on paper forms if you already have that information in the computer?” Far be it for me to question their routine.
Another nurse came, since they were changing shifts, and he hooked the patient up to a few monitors. He entered some more info into the computer. A doctor finally arrived and went through the same line of questioning and did an examination. Blood was eventually taken, an EKG was done and they decided to admit her overnight for more tests and observation. One nurse gave her some medication and used a bar code scanner to enter the medicine information into the computer.
Throughout this 5 hour process, as many as 10 people entered information into the patient’s medical records and everyone of them wrote information onto paper forms. I also saw some of the doctors and nurses using smartphones and iPads for some things. I wasn’t sure if this was for the hospital or they were checking the score of the Boston Celtics game.
The piece de resistance was when a nurse came into the examining room to take the patient to a hospital room and handed me a six inch thick binder of papers to hold. This was the patient’s records for this current stay and her 3 previous stays. We were taking it upstairs to give to the nurses on the floor.
I was speechless. If they have all this information electronically, why are they handing a book of paper to the nurses and doctors? If many of the clinicians are using tablets and smart phones, why aren’t they doing this for patient care? And why all the redundancy?
This hospital seems to be caught between old ways of doing things and modern technology. On the one hand, scanning a bar code on a medicine package before administering it is very efficient. It immediately shows up in the medical record, keeps track of the medicine and relieves inventory. Having three people jot down information about prescriptions onto different forms seems incredibly inefficient. And as far as I could tell, none of them shared the information.
Shuffling all this paper is very inefficient and a security risk too. I could have pulled a few forms from the patient tome and walked out the door with them. They had private health information, a social security number and other personal information. I also saw doctors and nurses signing a lot of forms. They should use an electronic signature or just login with their account in the computer system to authorize something.
The sooner they move from paper to electronic the better. This will let clinicians access information quickly and improve care. I saw PCs and tablets all over the hospital, so they do have the tools to access the information.
The last item that made me laugh was in the wing of the hospital where the patient was staying. When I walked onto the floor, I saw a large whiteboard with patient names, room numbers, dates and other information. Around the corner, there was a large monitor with the same information. I could easily see both from where I was standing. It seems some people want to stick with the old routine, while others are embracing the new.
Photo credit Medill DC