Contemporary Issues in Medical Informatics: Good Health IT, Bad Health IT, and Common Examples of Healthcare IT Difficulties
Informaticist can't escape clinical IT issues even on personal business

Informaticist can't escape clinical IT issues even on personal business


It seems this informaticist cannot escape clinical IT issues, even on personal business.

I took my 81 year old mother to see her internist at a hospital in which I'd had some training, a large regional center, for a followup to her recent ED admission and hospitalization. Her internist is part of a large multi-specialty group.

There had been a new EHR system in the E.D. where she'd been admitted. I'd watched medical and nursing staff in the ED, some of whom I knew and one who'd been a high school classmate struggle and complain (to me) about a UI that was cognitively overwhelming -- I'm being generous -- as well as undersized monitors (15" and 17" is passe today, no?) compounding the difficulty, and other issues. However, one item I could easily read was the name of every patient in the ED and basic information about them, since many of the monitors faced outward into the ED corridors where people (patients, clinical staff, family) walk.

For my mother's followup visit, in my pocket was a document I'd received a few days prior in the mail. The document was an x-ray report of an orbital injury suffered by a female patient, that had been ordered by me, with my name & address at the top. It was bound for my former residency director, now Chief of Staff.

The reason I was taking it there: I have not done clinical business with that hospital in ~ twenty years, and in fact have not ordered x-rays on anyone in over ten. A computer glitch seems to have occurred - somewhere - that put my name and address on top of an x-ray report of a woman I did not know, who'd apparently been hit in the eye, and sent directly to my home address.

I returned the x-ray report to the Chief of Staff, a friend, for investigation. Then I took my mother to see her internist.

We went to the practice's main office but were told we needed to go upstairs to an alternate one.

At the alternate office my mother waited ca. 2 hours for her appointment, which was unusual.

It turns out the practice, a large multi-specialty group, had recently 'gone live' with an EHR. The EHR project was apparently led by a cardiologist who lacked formal medical informatics or IT background.

I got a peek of the UI of this EHR through an open office door opposite me in the waiting room, and what I saw was also cognitively dense and, I might add, actually ugly. Docs and support staff were having problems with the EHR. The support staff member my mother had known for years related she's "never going to learn how to use the thing bacause it's too hard for a non-computer proficient person" and that the sessions in the "dark room they were sent for training" were not useful.

The reason for the office change, I was told, was that the cardiologists in the group had found the EHR was causing them to take significantly longer to complete their documentation than they'd expected. They had apparently sequestered the original office all to themselves for a two-week period, or longer if needed, to improve their learning curve and "get the kinks out", forcing the non-cardiologists to use the alternate office.

I write about these observations making only two additional comments:

First, a few years back I'd been a guest presenter at Medical Grand Rounds, and presented in a concise form many of the medical informatics lessons found in this website to most of the hospital's medical attending physicians.

Second, at this hospital I had recently inquired of the hospital if they were seeking medical informaticists, and the reply from HR had been that they were not.