Wednesday, April 11, 2007

On Ordering A Throat Culture, Or Scut Monkey Redux

If I haven't been blogging much lately it's partly because of a new entity that has taken over my professional life. It is called the "EMR," short for "Electronic Medical Record." It has utterly changed every aspect of how the clinic functions. For better ? For worse ? I'll let you decide.

The Old Way:

Me: Nurse, please do a throat culture on Mr Jones !
Nurse: OK ! (swabs throat, checks off "throat culture" on lab requisition, affixes labels, sends to lab.)
In the meantime, I extract a prescription pad from desk drawer, write prescription, hand to patient.

The New Way:

Me: Nurse, please do a throat culture on Mr Jones !
Nurse: OK ! (swabs throat, affixes label on swab, hands swab to me.)
Me: Mutter under breath and go to the "Electronic Medical Record"
Click on Mr. Jones' desktop "document."
Go to side bar.
Click on "CPOE & AP_CCC."
On CPOE & AP_CCC screen click on "Problem List"
On Problem List screen, click on "New Problem"
On "Find Problem" screen click on "reference list"
On reference list screen type "pharyngitis" in little oblong box
Choose one of several dozen "pharyngitis" entries and their accompanying ICD-9 (billing!) code
Hit save on this, "find problem" and "new problem" screens, which close, returning one to
Pull down new problem list menu and hope "pharyngitis" is there.
If it is, click on on "new order" button
Pop-up box tells me it cannot find "custom-list-CCC"
close pop up box
Stare at "new orders" screen
highlight "pharyngitis" on problem list (forget this and you're screwed -- no tests anymore without officially linked ICD-9 approved diagnosis !)
Find correct pull down menu among several and go to, "laboratory"
scroll SIDEWAYS to "microbiology"
hope desired test is on the EMR's parsimonious and weirdly arbitrary list of tests
(why, for example, does it include "parvovirus test" and not "shoulder xray" ?????)
otherwise go on confusing little side excursion after clicking "laboratory, other"
click on throat culture
click on "sign order"
click on "OK" (sometimes twice, God knows why)
wait 10-15 seconds as printer decides to print lab slip
sign lab slip and hand to nurse
hit "change medication" button (or is that "new medication" button ?)
stare at confusing screen
click on "new medication"
stare at another confusing screen
click on "reference list" (sometimes twice, God knows why)
type "penicillin" into oblong box
search among dozens of types of penicillins for correct one
hit "save" on a series of screens, which close and bring you to
confusing prescription screen
fill in several little boxes with dosage, instructions, duration, refills
remember to tell the machine what to do with the prescription (print, fax, fax & print etc etc etc)
hit save
find self (sometimes) back on "CPOE-A&P-CCC", sometimes on "medication" screen
If on CPOE click on "change meds" (or is that new meds)
If on "medication screen" hope "print" button is highlighted
if so, click on it
hope machine has not decided to fax
take prescription from printer
sign, write in DEA number

Realize, with bitter resentment, that the time spent doing these things would other wise havebeen spent writing the progress note that will now need to be written at the end of the day because THERE ARE 6 MORE PATIENTS WHO JUST SIGNED IN -- EEEK !

Remember, with horror, that the Mr Jones also had a fungal rash and wants some fungal cream.

Click, weeping, on "CPOE-A&P...."

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