Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Thursday, June 18, 2009

It Happened Again!

Almost two years later, I get a phone call eerily similar to an earlier letter:

"Hi, this is Dr. Oddi's office. We have a mutual patient here who says she had a colonoscopy done by Dr. Oddi several years ago, but we can't find it in our fancy-shmancy new EMR that we paid an arm and a leg for that isn't worth shit records. Do you have any record of it in your files?"

I go to the shelf. That's right: an actual metal shelf full of pasteboard folders containing bits of dead trees known as "paper." It takes me three seconds to find the right folder, and four more seconds to locate the report of a colonoscopy done less than a decade ago by none other than good old Dr. Oddi himself.

"Yep," I say, "I've got it right here"

"Could you please fax it over?"

Just think: If I were a modern electronophile with a completely paperless office instead of a luddite dinosaur with superbly organized paper records, poor Dr. Oddi would have been shit out of luck.


At Thu Jun 18, 02:24:00 PM, Blogger DancingSamurai said...

You can't blame that on the EMR... well, probably not. If it is the EMR's fault (randomly lost stuff), then it's obviously not worth the money they paid for it. Usually it's user error or people not bothering to spend the time/money to scan in pre-EMR records that they belatedly realize they need.

A good EMR has lots of advantages over paper records - but I'm fresh out of residency so paper charts are a dim memory from the first year of clerkship, no other clinic I work in has them any more, so I may be a bit biased. :)

The trick is to implement it properly, and pick a good software package. I prefer the open source OSCAR, myself. It's free!

At Thu Jun 18, 02:32:00 PM, Anonymous TreBob said...

A filing system is successful or unsuccessful according to the implementation. Dr. Oddi's office obviously failed to implement their's properly and so the patient (or in this case yourself) paid the price. Considering your earlier blog entry from 2007, this is an ongoing problem for them and not the result of an EMR. A poorly constructed EMR loses charts just as fast as a poorly constructed system based on dead trees.

Your EMR (if you ever implement one) and mine would have retrieved the woman's report, no problemo.


At Thu Jun 18, 07:12:00 PM, Blogger Nurse K said...

Doctors who don't know how to use EMRs blame the EMR for their incompetence.

At Fri Jun 19, 02:37:00 AM, Blogger Ambulance Driver said...

Probably user error.

Then again, an EMR with a non-intuitive user interface that allows such errors to frequently occur isn't much of an EMR.

And "Dr. Oddi."

Heh. Good one.

At Fri Jun 19, 07:28:00 AM, Anonymous James Wilk, M.D. said...

I got a note from an orthopedist--yes, orthopedist--about a patient I sent over to him about a distal fibula fracture and ankle sprain.

The EMR-generated report I received dutifully reported a full mental status was normal, that the extra-ocular movements were intact, the pupils equal, round and reactive to light, the oropharynx was benign, the dentition in good repair, that the neck was free of lymphadenopathy, jugular venous distention, bruit or goiter and that the trachea was midline....


I would bet my house, my car and my practice that orthopedist never looked above the patient's thigh, much less laid a stethoscope on her neck to listen for bruits.

Furthermore, it took me a lot longer to sort through the 3-4 page report for the impression and plan.

Things were better when reports of this sort were of the "Bone broke. Me fix" variety.

These EMRs do nothing but encourage fraudulent charting and fraudulent billing.

At Fri Jun 19, 08:52:00 AM, Anonymous Anonymous said...

"These EMRs do nothing but encourage fraudulent charting and fraudulent billing."

Referred to in non-medical circles as lying and stealing.


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