Nutrition Support Blog: We Need to Change the Change
November 7, 2013
In the very 1990’s movie Wayne’s World, one of the memorable quotes is one the main characters (Garth) saying “We fear change” in response to some proposed updates to his now successful TV show. I think everyone can relate to this sentiment because at times, even good changes can be accompanied by some discomfort or sense of unfamiliarity.
One of the most significant changes that I have witnessed since I started working in hospitals has been the transition from written to electronic medical records (EMR). EMR’s have been heralded as a hero that will save billions of dollars and reduce medical errors, but the EMR has also been villanized. There have been a number of excellent and thought-provoking editorials, letters and medical blogs highlighting problems stemming from the use of EMR’s. I highly recommend you take a look at the ones below:
--Hirschtick, R. Copy-and-Paste JAMA. 2006;295(20):2335-2336
--Toll, E, The Cost of Technology. JAMA. 2012;307(23):2497-2498.
Many of the problems relating to the use of EMR’s arise because of the tendency to ‘copy and paste’ or bring old sentences and paragraphs forward into new notes. Problems occur when the old statements are not edited and the new notes provide out of date information. I have witnessed notes from EMR’s where ventilator settings were mentioned on patients that were long extubated and out of the ICU, or where “lactate levels continue to rise” in patients who are no longer septic with normal lactic acid levels for days. When more and more information is pushed forward into notes, I have found that it now takes much longer to collect information to find out the main issues that are currently of importance with a patient. We are certainly not improving health care or saving money if it takes longer to find information, or if we are not sure of the accuracy of our medical records.
Considering that the system for written medical records evolved over more than 150 years, with a lot of tweaking over that time, we can’t expect EMR’s, or our utilization of them, to be perfect overnight. Undoubtedly, the systems, computers, and how they are used will continue to improve. What is important is that we recognize the flaws in our use of the current system, and begin to fix the problems. If we build a culture of denial, become defensive about our new technology because the costs were so dear, or write off those who identify issues as curmudgeons with a death grip on the status quo, we have no hope of fixing the problems before innocent people are hurt.
There is some comfort in knowing that criticisms of the way we document in the medical record is not a new thing. This famous video of Dr. Weed (see link below), known for promoting problem-based charting and the SOAP note format may look dated, but the basic concepts of effective medical records as a central component of good care is as valid as ever. You don’t have to drive an AMC Pacer, or have 1990’s hair to see that’s true….”Way!”
“Entities should not be multiplied unnecessarily”
– William of Ockham (1285 - 1349?)
“For a successful technology, reality must take precedence over public relations, for Nature cannot be fooled.”
- Richard Feynman