“I think computer viruses should count as life. I think it says something about human nature that the only form of life we have created so far is purely destructive. We’ve created life in our own image.” – Stephen Hawking

I think most electronic health records should count as destructive creations. I am going to have a stroke or go insane, one of the two, and it is not going to be pretty…


91 thoughts on “Virology

  1. Oh dear.
    My ex, driving a heavy lorry one day, got a call to ask why I, his then partner, had not shown up for my oncology appointment… was I okay? He nearly wasn’t.. nor the other road users as he tried to find somewhere to park long enough to get hold of me and find out what on earth was going on and why I hadn’t told him…
    Meanwhile I am at the rheumatology department waiting for the results of tests to be doled out… Nothing, as far as I was aware, cancer related. You can imagine the panic…
    I only hope the poor lady who really was due at oncology was okay.
    Far too easy formistakes to be made.

    Liked by 3 people

  2. You make a very valid point about physician’s growing frustration with EMRs. Computerization is contributing to physician burnout. Unfortunately it looks like it is one of the stressors that is here to stay, but hopefully will continue to evolve.

    Thanks for sharing your thoughts and feelings on your blog.

    Liked by 2 people

  3. Your comment above is right Victo – it would be OK of they spent some time with you. That is the crux of it. Most major programs are not written with the continual input of the users. They are designed by computer geeks to meet the specs of administrators – and everyone forgets the users. The last major program I worked on, we had weekly meetings with a select group of real users and ran the code we had in test and got input and even allowed them hands on the keyboard to try what we had developed and give input.. It is a lot of work and sometimes results in rewrites, but in the end it is the ONLY way to build a program that works best for the users.

    Good luck.

    Liked by 6 people

      • Thank you Victo – it was just about the most frustrating activity I had ever been involved with – and in the end it was amazing. We had many stakeholders – Acc rec, acc payable, store receiving, store mgmnt, VP finance, VP IT, etc. And it took us (a team of 16, of which I was the business analyst and was writing the product spec – what the users saw, and from that the coding logic) 2 years to build the program and it was hair-pullingly frustrating because so many people had input who had no idea how to even express what they needed until they saw it. And when we were done and rolled it out to 110 retail stores (5,000 users controlling 1 billion dollars in inventory and accts payable entering over 1 million invoices a year), it went so smooth that we halved our roll out time. And the number of bugs and complaints was only a fraction of what we expected. It came on-line with a crash and worked well from day 1 and still does – and that was 10 years ago. All the pain was up front in the proper development – and the end result was a gem. Not many bother to develop programs that way – and on my mind, it is the only way.

        Liked by 2 people

    • Such is the case with most technology, the designers are out if touch with what ‘real-world’ users need/want. They have a grand idea and breathe it to life. But without beta testing in ‘real-world’ settings what they’ve created is just an expensive, highly technical headache!

      Good luck doc! Sorry…

      Liked by 1 person

  4. Sue Vincent points out a problem with Electronic Health Records–getting the right patient–that is a major problem and one that will only get bigger. It will get bigger because it is addressed in only the most rudimentary way. When we actually address the identification problem, there will be a fight reminiscent of the fight over the Social Security Number as a universal identifier in the ’70s. That fight went on for years, damaged the SSN as an identifier, and left us with inconclusive results. A universal patient identifier has the same issues except that life and death are potential consequences instead of mere privacy. But, I suspect that is not the issue that prompted your post.

    Many different document types are also a potential problem leading to difficulties creating, storing, finding, and displaying them. Different EHR providers means each has its own way of doing these things, and that may well lead to problems importing, exporting, and exchanging records as people move around and change health care providers. Importing the wrong information because the patient was incorrectly identified somewhere could have lasting effects on the health of the patient. But, I suspect that is not the issue that prompted your post.

    Then there is HIPAA, or perhaps more importantly, individual providers interpretations of HIPAA. Certainly an inconvenience. Probably not very effective. But, that’s not new, and I suspect not the issue that prompted your post.

    Sigh. EHR is a hard problem (technically), but that won’t stop us from selling you something before the issues are even identified, let alone solved.

    Liked by 2 people

  5. Adoption of our EMR is when I had to go on Prilosec. I’d never suffered from acid reflux before then. What was really fun is when the system went down, and we had to go back to paper notes for the day. Then, later, when the system came back on, we got to input all the patient data from our paper notes into the EMR. Late nights. Good times.

    That’s my long-winded way of saying I feel your pain.

    Liked by 2 people

  6. There is a certain irony here. The EMR’s seem to be frustrating and dehumanizing. Stephen Hawking equates the use of computer technology as something akin to a virus yet he would be left unable to communicate and become totally immobile without this technology. I guess there is good and bad to almost everything.

    Liked by 3 people

      • I wouldn’t think to use the word destroying, but then it could. The more time we spend on computers, the harder we must work to stay in shape. Our bodies were not made to sit and stare at a screen and type as much as we are being told to do. Then there’s all the kids so dependent on phones and games….. I sometimes wonder what it would be like if all the systems went down for very a long time. In some ways, I think it would be a nice change, but so many people would totally lose it.

        Liked by 1 person

      • It is a fascinating thing that I think about all of the time! The trade offs we get. Our sedentary lifestyles without sunlight equal osteoporosis, vitamin D deficiency, obesity, anxiety/stress, and on and on and on… with the subsequent permutations. Is life really that much better or healthier now than it was back in the dark ages of medicine? Maybe not so much…

        Liked by 2 people

  7. Why limit yourself? You can have a stroke and go insane. And your head could literally explode. Fact. I read it on the Internet.

    My observation is that the people who develop the software never come in contact with people who actually use it.

    Liked by 1 person

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  9. Last year my team went through a new product from the current EMR we have. We wrote 25 pages of errors that we found including wrong intervention choices and erroneous meds. Fortunately we did not bring it in house. What would be a normal 1.5 -2 hour admission, would take 6 – 8 with all the documenting. It is based on logic and branching and it would only reveal the next step if you completed the process you were on. It was an nightmare. Clearly not written with the end user in mind.
    But I remember paper…… lost files, illegible writing, and forget privacy and HIPAA.

    Liked by 1 person

  10. EMRs have so many wonderful things-I don’t have to struggle to read some disrespectful provider’s penmanship. But none of them work without training and provider input. Templates are key. I will not work anywhere that uses NextGen. EVER! Weirdly, I LOVE EPIC because if you take the time to get the information in there right, it is wonderful. So much depends on the training on using the darn system. The I am using now, is such a time suck. I could free type the whole visit in the time it takes me to click through the HPI. Crashes many times a week. EATS my orders for labs. Do they have any additional training for you so you can figure out the sticking points?

    Liked by 1 person

  11. I still remember the day when I was still working as an RN in an SICU, how we were told computers were about to be installed and they would make our job so much easier and simpler. What a LIE! I would prefer going back to longhand notes, believe me. Computers, technology in general, have complicated our lives to the point, it has taken over our lives, grabbing at our humanity and our time. FYI … I just saw a movie about Stephen Hawkings. A fascinating story! You talk about inspiration? Wow! Have a good day, Doc. You are too young to go bald! (((HUGS))) Amy

    Liked by 1 person

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  13. the whole concept of electronic records is a misnomer in itself..when we get an escript at the pharmacy, guess what happens, it automatically gets printed, scanned and filed away just like a regular script! >:-( so much for saving paper, and time…

    Liked by 1 person

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