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(The Atlantic)   A look at why doctors and nurses will continue to use pen and paper instead of modern technological marvels like tablets and computers   (theatlantic.com) divider line 113
    More: Interesting, James Fallows, tablets, electronic records, stimulus bill, medical system, nurses, modern, doctor's visit  
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11061 clicks; posted to Main » on 07 Apr 2014 at 5:23 AM (1 year ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2014-04-06 10:37:34 PM  
Docs can dictate and some places ,especially ER's have a 'scribe' that follows doctors around and writes what they say.

Nurses can't do that. I can chart a lot in two minutes, but if I have to type it and move between screens and click boxes it takes five minutes.

If I wanted to be in IT I would have gone into IT. If I wanted to be in accounting I would have gone to an accounting firm.... oh wait I did and I get paid 3X what I did as a nurse.

I like caring for patients, I don't like charting for lawyers. At this rate we will burn through nurses much quicker than we were before. I don't know of anyone my age who plans to retire as a nurse doing patient care. Lots of them are going into reviews, telephone nursing, data set management for government compliance, emr training and implementation.

Congratulations you have a crack IT staff of RNs..... now who takes care of the patients?
 
2014-04-06 11:48:01 PM  
Strange.  The last several doctors offices I've been in, both the doctor and nurse have carried tablets and made all the notes right there in the room.
 
2014-04-06 11:55:44 PM  

feckingmorons: Congratulations you have a crack IT staff of RNs..... now who takes care of the patients?


www.pinktentacle.com
 
2014-04-07 12:05:43 AM  
csb

Made a call a few shifts ago to a nursing home. The staff didn't know much of the patient's history, no surprise. They bring me his file and it's mostly the power of attorney, DNR, etc. I finally find something from a doctor's appointment 3 years ago. It was completely unreadable gibberish. Most of it looked like wavy lines, with punctuation peppered in here and there. So yeah, seems like technology would help out. A lot

/csb
 
2014-04-07 12:07:40 AM  
The way economists would describe this is that the medical marketplace is broken.

www.myfacewhen.net
 
2014-04-07 12:11:00 AM  

Peter von Nostrand: csb

Made a call a few shifts ago to a nursing home. The staff didn't know much of the patient's history, no surprise. They bring me his file and it's mostly the power of attorney, DNR, etc. I finally find something from a doctor's appointment 3 years ago. It was completely unreadable gibberish. Most of it looked like wavy lines, with punctuation peppered in here and there. So yeah, seems like technology would help out. A lot

/csb


As a RN I can read that sort of thing. I find it much easier to read a two page H&P and a nursing note than scrolling through 12 different screens on a monitor. Sure, labs and dictated things like surgical notes, radiologist's reports, discharge notes are fine in a computer as they're typed by transcriptionists. I didn't want to be a transcriptionist (or a scheduler or a hospital administrator) I wanted to be a nurse. Now I'm not a nurse in the US any more, I only practice on medical trips to other countries where I get to be a nurse not a clerk typist.

What exactly do you do that you call on nursing homes?
 
2014-04-07 12:35:27 AM  
Both my doctors type notes directly into laptops.

*shrug*

YMMV
 
2014-04-07 12:36:02 AM  

BizarreMan: Strange.  The last several doctors offices I've been in, both the doctor and nurse have carried tablets and made all the notes right there in the room.

 
2014-04-07 01:04:47 AM  

optikeye: feckingmorons: Congratulations you have a crack IT staff of RNs..... now who takes care of the patients?

[www.pinktentacle.com image 468x506]


medobear?
 
2014-04-07 01:10:09 AM  
My doctor has had a tablet computer for years. Prescriptions are entered into the computer and printed out at the nurse's station or sent directly to the lab or pharmacy.
But what do I know? I'm not a nurse/cop/accountant/restaurateur.
 
2014-04-07 02:00:50 AM  

optikeye: feckingmorons: Congratulations you have a crack IT staff of RNs..... now who takes care of the patients?

[www.pinktentacle.com image 468x506]


AAUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGGGGGGGGGGGHHHHHHHHHH H HHHHHHHHHHHH!


*empties shotgun at the evil bear-bot*
 
2014-04-07 02:28:15 AM  
So EHR is the ICD-10 for Obama's ovens?
 
2014-04-07 02:30:56 AM  

doglover: optikeye: feckingmorons: Congratulations you have a crack IT staff of RNs..... now who takes care of the patients?

[www.pinktentacle.com image 468x506]

AAUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGGGGGGGGGGGHHHHHHHHHH H HHHHHHHHHHHH!

*empties shotgun at the evil bear-bot*


I don't think you have too much to worry about, it doesn't look like that cord will reach very far.
 
2014-04-07 05:29:09 AM  
There are many, many systems of filing patient data. The problem is is that there are many, many systems, rather than a centralized and secure system for patient data. This means that you still spend a lot of time transferring data from one system to another.

But considering how much trouble the government had making a website, the hopes of a government funded and operated centralized system is kinda low at this point.
 
2014-04-07 05:29:47 AM  

feckingmorons: Peter von Nostrand: csb

Made a call a few shifts ago to a nursing home. The staff didn't know much of the patient's history, no surprise. They bring me his file and it's mostly the power of attorney, DNR, etc. I finally find something from a doctor's appointment 3 years ago. It was completely unreadable gibberish. Most of it looked like wavy lines, with punctuation peppered in here and there. So yeah, seems like technology would help out. A lot

/csb

As a RN I can read that sort of thing. I find it much easier to read a two page H&P and a nursing note than scrolling through 12 different screens on a monitor. Sure, labs and dictated things like surgical notes, radiologist's reports, discharge notes are fine in a computer as they're typed by transcriptionists. I didn't want to be a transcriptionist (or a scheduler or a hospital administrator) I wanted to be a nurse. Now I'm not a nurse in the US any more, I only practice on medical trips to other countries where I get to be a nurse not a clerk typist.

What exactly do you do that you call on nursing homes?


As a tech person, that says a lot about crappy UI design and little about inherent disadvantages of using computers for these tasks. (I happen to believe that most UIs are poorly designed, but this is definitely an area where competent UI research would be well worthwhile.)
 
2014-04-07 05:30:44 AM  
Obamacare will force them to all use the Coby Kyros.
 
2014-04-07 05:38:33 AM  
My doctors and nurses all use laptops and tablets. They don't have a problem with them at all, and they now have complete records of my history rather than my blurry memory and doctor notes that may or may not be detailed enough or even exist or be bothered to be faxed.
 
2014-04-07 05:45:57 AM  
I can't think of a doctor's office (pediatrician, GP, gyno, dermatologist, optometrist) I've been to in the last three or four years that doesn't use laptops and/or computers in each room for both the nurses and doctors. They generally don't seem to have any trouble with them (they don't take an inordinate amount of time to enter anything in) and it keeps everything straight so I don't have to remind my doctor that I was taking this mg of a med, not that mg or that my headaches are fine, thank you.

/seriously, paper for record keeping is antiquated
 
2014-04-07 05:51:43 AM  

ChuckRoddy: There are many, many systems of filing patient data. The problem is is that there are many, many systems, rather than a centralized and secure system for patient data. This means that you still spend a lot of time transferring data from one system to another.

But considering how much trouble the government had making a website, the hopes of a government funded and operated centralized system is kinda low at this point.


I just moved and my old doctor kept everything in a regional system.  Records, tests, treatment, history, etc.  I've only moved 90 miles, but my new doctor couldn't transfer all of the records to the new system, which is also regional, so I spent two months getting blood work, going in for visits, and establishing a new file while I assume some poor sap attempted to shoehorn in my old information into the new system.

It's enough to make me look into MS's Healthvault, or any service like that.  At least then I know I'm keeping a solid history for myself, but I'm not sure I trust Microsoft that much.
 
2014-04-07 05:55:52 AM  
I thought it was all going to be about just needing an actual Signature for a prescription. Jeesus! The whole article is full of this mush mouth gibberish! "This is a subset of the general brokenness of the medical marketplace," WTF is a Subset anyway? Isn't that a mathematical term?  If it's Broke or broken I can get that. Brokenness? Is that actually a word? There are people out there these days who have learned to make a living out of using and making up words that most of us rarely use. The thing is that some people buy this crap.
 
2014-04-07 06:01:22 AM  
Soon, the elusive non-legible handwriting of doctors will become extinct. Leaving my handwriting with no companion.

/even RNs can't read my writing
 
2014-04-07 06:01:36 AM  

ChuckRoddy: There are many, many systems of filing patient data. The problem is is that there are many, many systems, rather than a centralized and secure system for patient data. This means that you still spend a lot of time transferring data from one system to another.

But considering how much trouble the government had making a website, the hopes of a government funded and operated centralized system is kinda low at this point.


I don't know if healthcare could acheive both centralized and secure. Afterall, the bigger a system the bigger the prize for whoever figures out how to crack it.
 
2014-04-07 06:05:28 AM  
Meh.  The established practices I've seen are the most resistant to going paper-less.  So, without RTFA, I'm going with generational thing that will sort out in a little while.  Just like doctors usage of MRI and CT versus just using x-rays.

I'm more interested in the privacy and security issues.  I don't like my credit reports, SSN, and all the other stuff out there now, so I'm sure I am going to be unhappy the first time I get a letter about a security breach at my doctor's office.
 
2014-04-07 06:16:20 AM  
Because your doctor is either:

A- a sixty year old man
B- working for a hospital where a seventy year old donor decides where money is spent.
C- you work at a doc-in-the-box franchise owned by a 30 year old with no more money (give it 10 years or so)
 
2014-04-07 06:20:14 AM  
Let me guess. Main reason is money?

/dnrtfa
 
2014-04-07 06:20:22 AM  

ChuckRoddy: There are many, many systems of filing patient data. The problem is is that there are many, many systems, rather than a centralized and secure system for patient data. This means that you still spend a lot of time transferring data from one system to another.


This. I work in a hospital setting and have to send off for various medical records. It'd be wonderful if we had a better way to get records from other hospitals than by fax or hand delivery, but the different operating systems kind of stand in the way of that. If we want to upload any other hospital's records, we have to scan them in as image documents.

I think that the different OS is part of the reason why moving to fully electronic records is so slow going. There's no incentive to go completely electronic when your hospital might be the only place using that specific type of OS and your people have reasonably easy access to the existent records. Transferring records to another hospital? Nah- we don't want them to go elsewhere and take their money with them. Unless they have no money, at which point they're perfectly happy to transfer them to the state hospital in the low income areas and send their MRs with them.
 
2014-04-07 06:24:47 AM  
As a pharmacist I can tell you that electronic records and prescribing can't come soon enough. Transcription errors, bad spelling, and bad handwriting kill thousands every year, and there is no reason for it. We do need better handwriting software and streamlined systems, as well as secure, encrypted transmission and storage, but it's got to be done. It's about people, not convenience.
 
2014-04-07 06:32:53 AM  
I do tech support for a hospital system so I'm getting a kick...etc.

More and more hospitals are adopting software that consolidates dozens of different applications to manage all of the department-specific needs that various facilities have.  The problem is training everyone to use it properly and ensuring that everyone has the access they need.

That's easier said than done when it's not unheard of to spend 20+ minutes walking someone through a password reset....
 
2014-04-07 06:42:45 AM  
I work in hospital IT.  I'm getting a kick out of this, etc, etc

//every little thing she does is MEDITECH MAGIC...
 
2014-04-07 06:46:31 AM  

abhorrent1: Let me guess. Main reason is money?

/dnrtfa


With the computer systems and training costing an arm and a leg, this would be one, but with many practices joining up with or already owned by major corporations, the financial sting is significantly less than what would be experienced by a single-doc practice or small group.

Not to mention that Medicare has declined to reimburse doctors who have yet to go electronic by now, if memory serves.

When I left the human medical profession as a career receptionist, the doctor was still pen-and-paper and it worked. The cost to upgrade the computer system, digitize the patient records and train the staff was simply too much. He was essentially forced out of business, short of selling his practice to a corporation, which he refused to do based on the principle that he wanted to run his own practice.

I did temp as a receptionist for a surgeon who had all EMR, no paper at all, voice-recognition software on the doctor's computer and faxes could be sent/received at the click of a mouse. The amount of paper shredded was amazing, from correspondence that had to be scanned, to paper checks for payments and scratch paper. I actually liked the whole thing, but when there was a problem, which happened about once or twice a month, the entire office screeched to a halt and all we could do was just cope with what we had paper-wise (which wasn't much in terms of patient records or scheduling).

In the vet clinic where I work now, we are still mostly paper, but try to keep enough information in the computer so that a printed history gives relevant information. No idea if/when we'll go completely electronic.
 
2014-04-07 06:50:49 AM  

dragonfli: I work in hospital IT.  I'm getting a kick out of this, etc, etc

//every little thing she does is MEDITECH MAGIC...


the cerner the industry adopts electronic medical records and charting, the better off we all are.
 
2014-04-07 06:50:55 AM  

feckingmorons: I can chart a lot in two minutes, but if I have to type it and move between screens and click boxes it takes five minutes.


While I don't doubt that you might have to deal with terrible software (a lot of industry-specific software is terrible, and healthcare software doubly so) and there are legitimate ergonomic challenges, nurses have been making that complaint since computers arrived in the 1980s, and since the 1980s actual time studies have shown the complaint to be false -- computer usage almost universally improves productivity in nursing.
 
2014-04-07 06:51:11 AM  

ksdanj: BizarreMan: Strange.  The last several doctors offices I've been in, both the doctor and nurse have carried tablets and made all the notes right there in the room.

 
2014-04-07 06:55:02 AM  
Lol. Repenting for sins is a waste of time. There's no hell below.
 
2014-04-07 07:00:25 AM  

Lapdance: I thought it was all going to be about just needing an actual Signature for a prescription. Jeesus! The whole article is full of this mush mouth gibberish! "This is a subset of the general brokenness of the medical marketplace," WTF is a Subset anyway? Isn't that a mathematical term?  If it's Broke or broken I can get that. Brokenness? Is that actually a word? There are people out there these days who have learned to make a living out of using and making up words that most of us rarely use. The thing is that some people buy this crap.


DEA requires a doctor's actual handwritten signature on c2 narcotic prescriptions, which is a pain for everyone, pun intended. If data encryption were more reliable, docs could send those scripts from a computer as well.
 
2014-04-07 07:06:58 AM  
When I had heart surgery last year, all the admission/consent/etc. forms were on a tablet.  If I wanted hard copies, there was a wireless printer right there on the reception counter.  All I had to do was click the box for Hard Copy, and there it was.  I was quite pleased.  Plus, everything was pre-filled out with all of my known information from a previous visit ;)
 
2014-04-07 07:12:28 AM  
s3.amazonaws.com

I went to Kaiser to have a cyst under my scalp checked out.  The doctor looked like she was 25.  She said "ew."  And she asked me if I had a temperature.

Mike Judge wins.  We don't need script readers in hospitals.  I'll use the effen clipboard to fill out 15 minutes of paperwork.
 
2014-04-07 07:14:14 AM  

Lapdance: I thought it was all going to be about just needing an actual Signature for a prescription. Jeesus! The whole article is full of this mush mouth gibberish! "This is a subset of the general brokenness of the medical marketplace," WTF is a Subset anyway? Isn't that a mathematical term?  If it's Broke or broken I can get that. Brokenness? Is that actually a word? There are people out there these days who have learned to make a living out of using and making up words that most of us rarely use. The thing is that some people buy this crap.


I think what they are trying to say is "only the 'gubmint can save us."

Fact is the technology exists, and is in use use.
 
2014-04-07 07:22:54 AM  
lol old people lol

"I kin write mah notes IN CURSIVE faster than some young wizz can be typing onto their computer machines with the mouse thingies and the screens with all the colors and whatnot."
 
2014-04-07 07:23:38 AM  

Lapdance: I thought it was all going to be about just needing an actual Signature for a prescription. Jeesus! The whole article is full of this mush mouth gibberish! "This is a subset of the general brokenness of the medical marketplace," WTF is a Subset anyway? Isn't that a mathematical term?  If it's Broke or broken I can get that. Brokenness? Is that actually a word? There are people out there these days who have learned to make a living out of using and making up words that most of us rarely use. The thing is that some people buy this crap.


Seriously? You've never heard the words "subset" or "brokenness" before? Are you a new arrival to this planet?
 
2014-04-07 07:27:23 AM  

feckingmorons: Nurses can't do that. I can chart a lot in two minutes, but if I have to type it and move between screens and click boxes it takes five minutes.


This. Half my damn shift consists of repeatedly taking fifteen minutes per patient to essentially say that nothing has changed and their pneumonia or stroke or organ failure (or whatever) hasn't magically vanished in the last couple of hours. The UI is terrible and there is so much redundant charting required it makes me want to scream. Maybe I should look into accounting. :)
 
2014-04-07 07:29:29 AM  

BizarreMan: Strange.  The last several doctors offices I've been in, both the doctor and nurse have carried tablets and made all the notes right there in the room.


My ped does this. Our preferred hospital has computer terminals bedside, and scans your bracelet before administering meds.

And don't even get me started on the VA. the only paper I see is the appointment reminder they still insist on mailing.

I can even access all of my records directly online.
 
2014-04-07 07:32:04 AM  

dragonfli: I work in hospital IT.  I'm getting a kick out of this, etc, etc

//every little thing she does is MEDITECH MAGIC...


I worked in Hospital IT back in 2001 and the hospital I worked for was more worried about trying to get a new building than update any of the IT software. So we had decent enough computers and laptops running an old DOS version of Meditech. It was a nightmare with no mouse support. Miss the right field and you better be quick with that TAB button to get back around again.
 
2014-04-07 07:33:01 AM  

johnnieconnie: Both my doctors type notes directly into laptops.

*shrug*

YMMV


Same here.  They use netbook-type computers at my doctor's office.  They made the switch something like 6 or 7 years ago.

Paper does have one *MAJOR* advantage over electronic data:  Security.  You can't be sitting in your mother's basement (or the basement of the NSA, for that matter), and access a paper record at a doctor's office.
 
2014-04-07 07:38:26 AM  

feckingmorons: If I wanted to be in IT I would have gone into IT.


Ticking off check boxes and typing notes isn't really an IT function.
 
2014-04-07 07:39:24 AM  

JackalRabbit: dragonfli: I work in hospital IT.  I'm getting a kick out of this, etc, etc

//every little thing she does is MEDITECH MAGIC...

the cerner the industry adopts electronic medical records and charting, the better off we all are.


EPIC posts you two
 
2014-04-07 07:42:47 AM  
I'm in Wisconsin this week for the spring Epic conference, so I'm getting a kick out of these replies.
 
2014-04-07 07:43:07 AM  

RaceBoatDriver: I went to Kaiser to have a cyst under my scalp checked out.  The doctor looked like she was 25.  She said "ew."  And she asked me if I had a temperature.

Mike Judge wins.  We don't need script readers in hospitals.  I'll use the effen clipboard to fill out 15 minutes of paperwork.


Just as an FYI, that picture just shows what 95% of doctors do already, compare a list of symptoms to a list of disease symptoms. I'm not saying it's easy, especially to get the relevant symptoms out of a patient, but having it all electronic can mean the check of symptoms are against a 100% up to date database instead of relying on a human's crappy memory and diligence in keeping up with medical advances.

I'd rather have a less erring robot doctor, honestly.
 
2014-04-07 07:43:13 AM  

fusillade762: doglover: optikeye: feckingmorons: Congratulations you have a crack IT staff of RNs..... now who takes care of the patients?

[www.pinktentacle.com image 468x506]

AAUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUGGGGGGGGGGGHHHHHHHHHH H HHHHHHHHHHHH!

*empties shotgun at the evil bear-bot*

I don't think you have too much to worry about, it doesn't look like that cord will reach very far.


How do you know it doesn't have batteries? And scimitars? And chainsaws built into the arms?

Can't sleep the evil bear-bots will get me Can't sleep the evil bear-bots will get me Can't sleep the evil bear-bots will get me Can't sleep the evil bear-bots will get me Can't sleep the evil bear-bots will get me Can't sleep the evil bear-bots will get me Can't sleep the evil bear-bots will get me .......
 
2014-04-07 07:46:54 AM  
Some hand written prescriptions look like a finch had its feet dipped in ink, and then walked all over
the paper. Deciphered it means this: Doctor to Pharmacist >> "I got my $80, now you get yours"
 
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