Saturday, February 14, 2015

IT Laments From An ER Doc
The 10th Anniversary Post on

Fellow blogger and ER physician Edwin Leap, M.D. has apparently discovered the joys of poorly written software I've been bemoaning for so long.

In a December entry, Dr. Leap opens with an apology for the behavior of some less-than-tech-savvy physicians:

I know that, on many levels, physicians must be the absolute banes of your existence. We are grumpy and resistant to change. And some of us are still confused by graphing calculators, much less complex modern computer systems. We call you because we forgot our passwords, then because we forgot the new passwords. We call because the system crashes and we call because the voice recognition doesn’t work and we curse the screen and shake our collective fists at things that slow us every day. I get it.

He's a bit more conciliatory in this than I've been, but he's right. There are some docs for whom the acronym P.B.K.A.C. (Problem Between Keyboard and Chair) is 100% applicable. These unfortunate folks are the inspiration for Dalai's XIIth Law
XII. The PACS needs to be operable by the least technically-savvy radiologist on staff.

That being established, Dr. Leap takes the gloves off, and picks up my battle-flag, starting with his disgust with his EMR.
However, there are some things that you and those who develop your systems need to understand. Allow me to elucidate.

We didn’t ask for EMR in its current incarnation. It is now a gargantuan billing and data collection industry, with precious little utility in our day to day practices. As such, your bosses love it because it squeezes the last gasping penny out of every chart. They write your checks, we don’t. Nevertheless, we have difficulty being excited about ever more fields to fill out, ever more time-stamps, ever more screening exams, and the caucophanous symphony of key-strokes and mouse clicks that echo through the modern hospital and threaten to muffle the sound of suffering and human interaction.
The vast majority of EMR's, CPOE's, etc., are unwieldy, unusable pieces of convoluted trash, which add to the hours of the already full day of a busy physician. More on this in a moment.
Next, passwords and security make a lot of sense to you. You dwell in a world of hackers and identity theft and you worship at the silicon altar of HIPAA. We, however, are busily seeing patients and trying to do it as quickly as possible in hospitals, clinics and especially ER’s that have no ‘off’ switch but which do track our ‘quality’ in part by tracking our speed and efficiency. Thus, we have little time to spend logging on. And when we step away to, say, intubate a dying patient, the last thing we want to do is log back on to 1) the computer 2) the hospital EMR system and 3) the particular department system and 4) the radiology viewing system. But here’s the really, really important part: nobody is busily stalking behind us trying to look at medical records or interpret xrays on strangers so that they can violate their privacy. We’re watching; trust me.

It was a nice idea but now it’s a poison. It is the law of unintended consequences on steroids. It’s all redundant, irrelevant, obnoxious busy work that stands between us and efficiency. If you really insist on it, then make it all biometric with thumb prints. Because tracking usernames and passwords is starting to take up more of our fragile brains than drug doses and diagnoses. And that, my friends, is not good.
Yes, security. We all understand the importance of keeping hackers and other slime out of patient data. I wonder how many passwords Anthem had that didn't prevent 80 MILLION records from being compromised. Screw passwords. Let's try biometrics, wrist-worn RFID's, implanted chips, retina scans, anything that will get the job done painlessly (well, after the chip implant, anyway). We simply don't have the time to re-log in 35 times per day.

You might recall my tale of IT tyranny from the same Laws of PACS lecture wherein I used AutoHotKey to create a little macro script that pushed the button that kept my RIS active. IT at first banned the macro because "someone might use the program to bypass a password screen." Yeah, right. They knew quite well that I was the only radiologist in my group capable of even understanding how that might be done, and they knew me well enough to know that I wasn't going to do it. I did win out in the end, but as usual, it was a battle that really didn't need to be fought.

Dr. Leap continues his velvet-gloved attack, documenting another pet peeve of mine, the inability of IT to grasp the mission-criticality of what we physicians do, day in and day out.
Now, about tech support and system back-ups. We have to use these systems. There is no option. And we have to use them 24/7/365. Because that’s when people get sick and die. Therefore, every system needs to have a parallel back up system that kicks in whenever a data transfer or update or repair or anything else is happening. ‘We’ll be shutting down for four hours’ isn’t an option anymore. Since ‘we won’t see heart attacks for four hours’ isn’t an option either. Furthermore, when things are going badly, when we need a reset password or when the computers are locked up in some loop that looks like an alien language, we need help immediately. We don’t need ‘a ticket’ submitted. A round-the-clock job that requires EMR necessitates round-the-clock IT. No questions asked.
And finally, my new friend the ER doc rediscovers the travesties I've been bellowing about for just over 10 years on this very blog:
Finally, to those who design these monstrosities and those who buy them to the protests of clinicians, what are you thinking? Medicine is about caring for patients. And anything you create that makes it more difficult is an insult. Shame on you. You should do better, for your staff and for the patients who ultimately pay your salaries and fees.
Dr. Leap ends with a leap of niceness toward IT that I wish I could manifest as well...
And for you IT folks, I’m sorry. I’ll keep trying to do better. I generally know where to find ‘start’ when I’m talking to you and I can actually navigate the directions you give in a fairly efficient manner. I know that the disc drive isn’t a cup-holder and that I have PC, not a Mac. I’ve even been storing my passwords on my smart phone! I realize you have a tough job; made tougher for dealing with physicians and nurses.

All I’m saying is this: I understand your frustrations. Try to understand ours!
Yes, IT departments, and particularly software vendors...TRY to understand our frustrations. I have been blogging for TEN YEARS, saying basically the same thing. A significant plurality, if not the vast majority, of medical software is utter, complete, unmitigated GARBAGE. It is designed by engineers with no experience in healthcare and tuned to the specs of bean-counters, with no experience in healthcare. It is pitifully clear that absolutely NO thought has been given to the usability in the hands of those who need to make these abominations work in the process of treating patients and hopefully saving lives. It is nothing short of criminal, but it is no surprise. These Rube-Goldberg contraptions are NOT selected and purchased by the people that use them, but rather by those beholden to the bean-counters or other administrative influences, and those who wish to have the easiest time servicing the product.

Sadly, even after 10 years, I don't know the solution to this situation. CIO's and IT departments are not about to give up their influence over these huge expenditures, and I'm not sure how to take it away from them. Perhaps the only thing I can do is to slap the vendors in the face repeatedly with the fact that their software sucks, and hope that the subsequent embarrassment will prompt them to clean up their acts. I'm not holding my breath, and I have grave doubts that I've influenced anything much at all. Perhaps once I'm fully retired, I can turn my attention more fully toward this effort.

In the meantime, the frustration continues, with potentially deadly consequences.

1 comment :

A Doc 2 Be said...

I'm shadowing an ID doc at the cancer center here... he laments the same issues with the disconnect between IT developers and the docs who have to use the crap they create.

Though, truth be told, I DO find looking at MRI, x-rays, and CT scans of lungs, sinuses, and other stuff fascinating :)