Thursday, July 28, 2011

Why has the Most Expensive Person in the Room turned into the “Data Jockey?"

In the old days, the healthcare provider would scribble a few orders, write a brief note and be done with the paperwork.

Times have changed.

When using a tracking board, CPOE, and Electronic Health Record, the healthcare provider is now burdened with inputting endless data to obtain accurate:
  •               Through-put times
  •               Door-to-balloon times
  •               Stroke alert data
  •               Time of EKG reading
  •               Time of consultation
  •               ETC., ETC., ETC. – The list is endless

This does not include the history and physical, clinical course, medical decision making, procedure notes, critical care documentation, Rx, and discharge paper work, and etc.

What kind of help is available?
  • Scribes work but are expensive.
  • Voice activated input like “Dragon Medical” dictation software   are worth every penny
  • A data gatherer who sets up record with everything except  HPI and MDM (college students are inexpensive)
  • You could do everything after the fact but times are inaccurate depending on the program used. This practice also burns providers out and increases the need for mental days off.

The provider is “bogged down” with endless paperwork regarding data entry which leads to lost productivity and less real-time patient contact and care. Switching to an EHR will take some adjustment time but it will help healthcare providers adjust to the role of  “data jockey.”

My ED uses a combination solution.

  • The king pin is an EHR charting program, XpressCharts EHR, that I helped developed. The program is user friendly, has the ability to created “favorites,” is dictation software compatible, and has a minimal need for user computer knowledge. The program can also be used easily without adjuncts.
  • Voice activated support that allows users to dictate in all text boxes. The EHR used, XpressCharts EHR, is set up to easily allow this which eliminates most typing.
  • College students serve as “data-go-fors”.

Monday, July 18, 2011

Treatment Protocols, Cookbook Medicine, and the Food Network

Treatment protocols for Sepsis, ACS, STEMI, GI Bleeding, Coagulopathy, Hypertension, Pneumonia, etc. have been created to aid the clinician in giving the best evidence-based treatment plans. These can be attached to the CPOE and be used easily. The advantages are not “reinventing the wheel”, using UTD treatment plans or bundles, and give the support staff parameters of how to adjust the medicines per response of the patient.
Criticism has arisen because this is cookbook, formulaic medicine that is unnecessary and intrusive, making the individual feel his/her plans are 
Our ED group has chosen to emphasize protocols for critical patients to give the patient the best statistical shot at success.

Being a fan of the Food Network and their creativity, it is apparent that cooking is a function of chemistry.  All the great cooks use basic protocols (recipes) to get started and adjust them with nuance and art.

The same can be done with medical protocols when they are used as a basic approach. The “Art of Medicine” (experience, knowledge, empathy, spirituality, gestalt) can then be added to make the protocols “state of the art”.