Don’t Touch My Things!

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“Your blood pressure is a bit high today. What has it been running for you at home?”

She giggled and grinned at me sheepishly.

“You know, Doc, I don’t check my blood pressure!”

I sighed my exasperated sigh and laughed with her. I knew, but I wanted to make a point.

“I know but if your blood pressure is running this high all the time, we need to start you on meds. If you were checking it at home, I could save you a copay for a follow-up visit….” I trailed off.

A puzzled look had crossed her face.

“But, Doc, I’m already on blood pressure medication.”

No she wasn’t. I had checked her med list before entering the room…

Then I remembered the office visit with the general surgeon the previous week that was on her record. On a hunch I clicked the convoluted series of tabs to pull up the list of deleted meds. 

There it was. 

Her blood pressure medication had been cancelled on the day of her visit with the surgeon by staff in their office.

We are all on the same electronic health record so they can mess with my med list, my medical and surgical histories, family histories, problems list…. Everything. 

And they do.

This is hard for someone like me who will freely admit that I have OCD and control issues.

Cue mustachioed face, spittle, wild eyes, and a dark Victorian suit ensemble: “I just don’t like other people touching my things!!!!” (From the movie Moulin Rouge in case you needed a frame of reference.)

This happens all too often and it worries me. Beyond being a major inconvenience, it is one of the hidden dangers of universal charting. 

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122 thoughts on “Don’t Touch My Things!

  1. In this day and age there should be, and I’m sure there is, a way to set up universal charting so that when someone on a patient’s “healthcare team” makes a change to a chart, the other the team members are notified, especially the team member that, say for instance, wrote the scrip for the blood pressure medicine in the first place.

    Liked by 2 people

      • My husband. We do, as do they, in North East Florida , cross check and reference everything, every little tiny spec of spoken or recorded information, with every visit. I ask more questions than most folk with military backgrounds are comfortable with. But the Docs and support staff seem to appreciate it . Maybe patients who are oblivious are more likely to have problems …. you do keep reminding everyone to at least keep track of themselves . There was and ER mix up of arm band IDs, that my husband saw/heard. If the patients had been unconscious ?????? And I did, myself, observe hygiene protocol broken, in VA and other ERs, with pediatric staff, and even in dentist’s offices. I ALWAYS say something as soon as I see it, trying to break the transfer before it actually is completed. I do try to do it quietly and unobtrusively .. if possible … Later would be too late …

        I think OC would be a good addition to most (other) medical staff resume’ . It would give Spouse/Family From Hell (me) nothing to do.

        Thank you for all that you have done.

        Liked by 1 person

  2. It’s a lot worse than a nuisance, but it’s something a system designer should expect. If you are building a container that can be accessed by lots of people (“lots” in this case would mean “more than 1”), and the people have different purposes, it is guaranteed that they will step on each other. That’s what access controls are for. As you have pointed out more than once, this group of users is not always a collegial group.

    Liked by 1 person

      • It is certainly a lot easier to build one big pot that everybody can mess around in as they see fit than to build something that has compartments. Why, in that case someone would that to apply some thought to figure out what the policy should be. Things will probably continue this way until some smart lawyer notices the liability created by not having access controls. I don’t know whether the liability can be made to stick to the EHR company, or whether it applies only to you, but it is certainly there.

        Liked by 2 people

      • EHRs generally are not considered a valid excuse in court, even if there are clear issues. I try to make patients aware of this and tell them to review their check out med list each visit for now.

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  3. I feel your pain. I hate when anybody touches my stuff…especially without asking me first. I think one of the issues around electronic medical records is the concern about privacy of the data. But it seems to me, with everyone using Facebook and Twitter, taking and posting selfies as well as where they are and who their with at virtually any time during the day, this concern about privacy is misplaced, especially when it comes to medical records accessed only by medical professionals.

    Liked by 5 people

    • I totally get privacy. This is not a privacy issue, though. I don’t mind all physicians having access to all of the data but dropping meds is dangerous. So is changing the histories sections. Some of the question has to be who has primary ownership of the chart. If that is me, then you can add to the histories but do not delete my content… If it is not me, then something has to be developed to compartmentalize the record.

      Liked by 1 person

  4. I find this extremely alarming from a patient and contract perspective.

    Contract Managers exercise versioning control; all document changes are marked with related time and date. If someone tries to circumvent that, it’s treated as a serious problem … and this is just for commercial contracts, not matters potentially impacting someone’s life!

    If a doctor is making changes, those changes should be clearly, mandatorily noted–by the software–with time, date and author. This is important for care provision and legal/litigation reasons. Gah! Gah, I say!

    Liked by 1 person

    • That IS noted but I cannot see when something is deleted unless I go looking for it. Ideally, staff would not be removing active meds. That should lie with the physician. When a staff member deletes something like a blood pressure medication they need to look up in the chart to verify if the patient is indeed still supposed to be taking it and maybe alerting the prescriber to let them know the patient said they were no longer taking it. Deleting without note of why is not cool.

      Liked by 1 person

  5. OH dear. That is terrible. I go to a specific practice because I have lots of issues and WANT the coordination of everybody having access to my records. Deletions should result in automatic notification (Warning, Will Robinson!)

    I will admit to once changing my medical history — with the consent of the nurse on duty — when details were wrong.

    Liked by 1 person

  6. Reminds me of a doctor calling me in for an appointment to discuss the statins I was on for my diabetes/cholesterol. I’m on no medication whatsoever for anything. He told me if he’d known that, he wouldn’t have called me in. (Multi-cultural surgery, never saw the same GP twice, and couldn’t understand them when I did). So glad things have changed since we moved!

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      • yeah. Even better was their diagnosis for a hip problem for my husband despite his emphatic denial. After multiple xrays he got an appointment with the hospital consultant. He said he didn’t have a hip problem, so my husband said ‘I know that, and you know that, but try telling my GP that’. The consultant said he would, in no uncertain terms at having his time wasted (anger not directed at my husband). Sadly, we had no other choice of doctor’s surgery where we lived and it was one of the main reason we were so desperate to move. All is OK now. We have a good GP and are both treated as patients, not some number on a tick list.

        Liked by 1 person

  7. Very scary where medicine is headed. Way not cool to have a system where anyone can make changes to YOUR patients. *shaking head* Privacy has gone right out the window with basically all in Life. Really scares the um defication out of me. (smile) (((HUGS))) Amy *holding up a protest sign!*

    Liked by 2 people

  8. Geeze Doc, our medication reconciliation requires a date/time stamp and the only person who can illuminate a med is the attending or prescribing MD. And even then, it stays in the record one click over. AND no one can change a record as we have EVA, electronic verification authorization and only the author can easily change something in the record with a log in and password, Otherwise you have to dance through hoops to get a record unlocked. But then we are not MD level in the charts.
    We are looking at EPIC and being connected with the Medical Center. We also have RHIO (I think that’s the initials) which is a cross member patient information system. You can only access info and not chart directly into it.
    I think HIPAA is overkill in the silliest things and not enough in other ways.

    Liked by 2 people

  9. This is worrisome to me. My mother in law (86) is taking more than 20 prescriptions from 3 different specialists. She is a walking pharmacy, trusting that these MD’s are coordinating her treatment. Most of the Rx’s she is taking are to counteract the side effects of another drug. When did it all get like this ????

    Liked by 2 people

    • It got to be that way when Pharmaceuticals became BIG BIG business, and insurance dictates. Many Docs throw medicines at patients because they want to just cover their butts…NOT YOU Doc. It is easier than going through an detailed holistic exam including nutrition, lifestyle and stress management. But then there are the non-adherent patient…. who “know” more than the Doctor. ( like me)…lololo

      Liked by 2 people

  10. Do use epic? I always have to look at discontinued meds to see if other providers are prescribing narcotics for our patients . I also have to look at pmp website but I’m always investigating every inch of the EHR. I am FBI undercover haha but I’m so used to looking at discontinued meds in every chart that it becomes my routine. Just a thought.

    Liked by 1 person

  11. That’s dangerous meddling with a patient’s meds and health. Happens too often and that is why just about everyone needs an advocate when seeing a doctor or when in the hospital. Someone has to watch everything that is going. But, your OCD can be a good thing!

    Liked by 2 people

  12. What this tells me is that the patient cannot trust the doctor. The patient must stay completely informed of what’s going on, read their own medical record, and correct doctors whenever they assume something that is inaccurate. I’ve done this numerous times with doctors, and they’ve always seemed very willing to correct errors.

    Liked by 1 person

    • You can generally trust the doctor. You cannot necessarily trust the system, however. And yes, you must always advocate for yourself and speak up when something does not make sense or is incorrect. Medicine is way too complicated now. The moving parts used to be very manageable when there were only a few drugs and a few disease management options.

      Liked by 1 person

  13. This is not at all what I expected Universal Charting would be. I was hoping there’d be requests that needed approval before something could be deleted. This is scary!

    I like compartmentalizing. It’s just how my OCD brain works. Everything must be neat and organized. This system seems like a huge mess that needs to be cleaned up quickly.

    Perhaps if they had a competitor/rival company offering a better system they’d make more of an effort to be less sloppy.

    Liked by 1 person

  14. Pingback: My Article Read (2-25-2015) | My Daily Musing

  15. Whenever I go to a doctor in my health system, they review all the “current” meds on my chart and ask me if I still take them or if I’m taking anything not on the list. The person that deleted the record of her medication should have asked her if she was still taking it. I wouldn’t just ask someone what medication they are taking because people will leave out what they don’t think is relevant. IF you are using a shared charting system, there is a responsibility to everyone who sees each patient. Something as important as editing someone’s list of medications at least warrants entering a note.

    Liked by 1 person

  16. This makes me so mad! How DARE they!!! YOU’RE her doctor, not them. And you said “staff’ as well so i am guessing they’re not doctors at all, medical professionals of other sorts maybe, but not doctors. It’s not just them touching things without your permission, it’s them even considering meddling with your work, at the risk of people’s LIVES! You should let them know how improper, how unprofessional and how much of a malpractice that is. If something happens to the patient, you will be the first to be pinpointed and you wouldn’t even have an idea what happened.

    Liked by 1 person

      • Man, this sucks. Reminds me of a video I watched yesterday saying that the medical world has already known of a cure for diabetes for years but has kept it secret because big pharmas still want to cash in on the ever-growing number of diabetes cases. makes me really want to check that out considering that my parents died mainly because of it and my sister is currently suffering a lot because of it. It could all be all hype but I still want to check it out, if it’s going to help my sister and maybe myself in the future (I am not diabetic and hopefully will never be).

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      • Yup, thanks for the warning. I know too well how unsafe such things can be. that’s why I just want to check it out first. But anyhoo, will most probably not do that. It just sucks, that’s all. My sister just had a laser procedure done on her eyes last Tuesday. That’s ’cause her sight became worse in recent weeks. She did use to have a poor eyesight, but not like that. So the procedure was suggested by two doctors and was then done. Then yesterday, we were all in a panic because she couldn’t see a thing except glimmers of light. Went to the doctor and was told it was alright, blood just wasn’t going up to her eyes fast enough. Her sight became better. Her sugar should just be maintained. But I was pissed off because my point is the doctor SHOULD’VE volunteered information on what to expect to avoid panic. They even asked the doc before what should be avoided and they were told none. How unprofessional.

        Liked by 1 person

  17. AARGH! This post ate two of my comments, and one was a literary masterpiece (that’s my story and I’m sticking to it). I’ll just say that you are not alone in your complaints about enterprise software – and that the administrators deliberately did this and are certainly aware of the issue, and have no intention of fixing it. The only hope you have of getting it changed is to point out to management that if there was ever a law suit over patient care and it became known to the lawyers that the primary care physician’s orders could be modified or deleted in the program without his/her knowledge – there is a huge legal liabilty big enough to give ambulance chasers wet dreams.

    Great post Victo.

    Liked by 1 person

      • I used to write the product spec (the actual screens that the user sees to do his/her work – the code is developed from the product spec logic) for big programs – one was a $10 million dollar enterprise receiving/payables/receivables for a 1.5 billion dollar retail operation. There are a number of reasons why your program is written the way it is and they may include: 1) administrators who ordered it do not know or appreciate the risk associated with the program processes; 2) the power users i.e. dept heads, etc, want to be able to modify any data if they choose- even if it means leaving the data unprotected (knowledge is power); 3) the IT supplier is charging for the features(and remember it is a one time purchase cost plus a yearly fee for programming, upgrades and maintenance) by capability (even though they have the whole program, they actually disable functionality unless the purchaser requests it – this allows them to nickel and dime you to death and your IT purchasers will avoid as many add ons as possible for cost (say you want to predict nephrostomy tube failures and their failures are a fuction partially of patient height – which they are as they are fixed externally, usually with a stich, and float internally in the kidney, so they fail more often when tall people stand or sit down – and want to sort your patient data base by patient height. This is info that is in the patient data base and can be sorted easily by any program with a simple search engine – but the suppliers will not give you that functionality unless you pay for the feature and a yearly upkeep fee – eventhough it costs them nothing.

        So, your program likely was influenced by one or all of the above so that data protection and notification fell by the wayside. When we wrote these programs, we did a detailed risk assessment of each feature to decide the liability and the marketing potential. Soemone, somewhere has not done their job wrt assessing liability especially in a medical program where people’s health and lives are on the line.

        Best of luck!

        Liked by 1 person

  18. That would be worrying. As a patient, I always make sure I keep tabs on my treatments,blood tests but I know many who have no idea and I can’t understand that. It’s your body and you need to know what’s going on. I work with my doctors as a team and we talk through options…unless I have no choice as in the cyclaphosphamide infusions. I was just told that time. xx Rowena

    Liked by 1 person

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