Please, sir, may I have an EHR?

Thank you, Andre Picard, for restating the case for a significant investment in the electronic health record. It can't come soon enough.

We (finally!) got the last 3 docs in our clinic on our EHR. Just the fact that our staff don't have to search out paper charts 100's of times a day is a huge bonus. I can hardly wait until the Health Region's lab computer can communicate with our system so results can flow directly into patient records. What are we doing in the meantime? Glad you asked.


We have the most ridiculous, Rube Goldberg system to get patient information from the regional lab into our patient records. The lab generates results electronically, makes them into faxable format, and faxes the results to us. Until recently, we pulled the faxes off the machine, SCANNED THEM BACK ONTO THE COMPUTER (!!!) and then assigned them to a patient's electronic record. (Recently, we got a program working that eliminates the re-scanning step.)

Aside from the amount of staff-time this takes, it destroys the potential of the data. If the lab results we received stayed in electronic format, then our computer could search for, say, all men with a PSA level over 10, or a creatinine over 300, or whatever parameter we wanted to track. But, as the information is stored as a picture of the data, the computer has no idea what information is actually contained in the file. If I want to follow a man's PSA level over several years, I have to re-enter that data into electronic form. Nice use of my time...

The waste (staff-time, opportunity to improve care, etc.) is staggering.

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What's wrong with this picture? - XIV - Oh, my aching neck!

Dictating hospital discharge summaries! Aaarrrgh! I don't know a single doctor who enjoys this necessary evil. (For those of you who haven't had the pleasure, a discharge summary is essentially the story of someone's hospital stay.) Not only does it mean 30 minutes of dictating reports, it also means 30 minutes of cranking my neck into an unnatural position to accommodate the terrible ergonomics of the phone receiver.

Check out the protruding vein on my temple - it's pulsating with annoyance.



Well, you may say, why don't you hold the receiver in your hand and save your neck?



Like this, you mean? Great idea, but that leaves just one hand free to flip through a voluminous, poorly organized and ergonomically-obscene paper chart, to reference lab results, progress notes, etc.

It's a frustrating experience, and that leads to rushed, and possible incomplete, discharge summaries.

I always use a hands-free headset in my office - it's comfortable and convenient. Why don't they have one in the hospital medical records dictating suite? As it turns out - nobody asked for one!

A couple of months ago, I spoke to the person in charge of this area and suggested they try setting up a headset. And...



Now check out the protruding vein on my temple - it's pulsating with joy!

I have 2 hands free to flip through the chart. (Electronic charts would be better!) I'm more likely to dictate a thorough discharge summary, because I'm not frustrated by the unwieldy chart, and my neck isn't cramped.

Not only did they supply the headset: (on one phone, as a pilot - excellent plan!)



They also posted an instruction sheet and a feedback form:





What a great demonstration of how to implement a change:

Address the client's need/problem.

Start with a small test of change.

Make it easy for them to try the new method.

Ask for feedback.

If you don't ask, you don't get! And it only took me 16 years to ask.

Kudos to Sherry M. for setting this up. Thank you very much!

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The grass is always greener on the other side...

Check out US President (not yet, but he might as well be) Obama's video blog of his Economic Recovery Plan. He's going to make sure that all US hospitals and doctors' offices are outfitted with EMRs and are connected to each other (3:50 on the video).

EMR and connectivity are part of his core plan. "Cut red tape, prevent medical mistakes and help save billions of dollars each year..." Looks like his administration gets it.

Who would have thought the American health care system would be showing us the way on this?

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Review of Doctor review sites missing an opportunity

Dr. Kent Sepkowitz informs Slate readers that doctor review sites aren't helpful for patients. But can they be helpful for doctors? I think so - check out this old post.

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More RateMD fodder

Here's a recent article from the Prairie Post. 1762 Sask docs listed on RateMD. There is no escape!

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Welcome CCHSE attendees!

Thanks for coming to my presentation of BOMB! How a (failed) career in standup comedy made me a better surgeon. I look forward to receiving your feedback. Please click here to take the survey. You'll need the password from your souvenir postcard!

This survey closes on Thursday, November 27.

P.S. Got time on your hands? Check out "What's wrong with this picture?"

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Come out swinging on private health care!

In this corner, CMA president Robert Ouellet weighs in on how private health care will improve access for Canadians.

In this corner, former NEJM editor Marcia Angell, takes a swipe at American-style privatization.

Judge's decision: Angell

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