Crossing Over

This new electronic health record?

It has been “optimized for a 24 inch screen”. You have to have a screen this size or you will waste 25 minutes per day doing extra scrolling and clicking. 

Or so they say…

A screen that size is not portable. We will have to have a computer in each room. Of course. Plus each physician will need a docking station in their office for their laptop.

This clinic that we are trapped in until 2018 has tiny rooms. It works carrying a laptop. I balance it on my lap while sitting on my wheelie stool facing the patient so I can maintain as much eye contact as possible. I try to type while we talk to maximize charting time and to ensure accuracy.

To have a computer in each room, given the room size and layouts, will require mounting it to an arm and using it with my back to the patient. That set up will cost about $3,000 per room. Each physician uses three rooms.

Paying for this will require seeing seven more patients per physician per month for three years at which time the computer equipment is obsolete and will have to be replaced.

Which begs the question, how do you do that with an already full schedule?!?!!!? 

Furthermore, why couldn’t this EHR have been “optimized” for a screen size that is more practical and portable? If this is the top of the line program, why wouldn’t they want portability? Who gets a cut of the equipment sales?


72 thoughts on “Crossing Over

  1. We had a dispatch system like that – it required a 24″ screen. We added a screen to each desktop so that the whole field was displayed across two screens – most processors today have the ability to run multiple screens. As an aside it added amusement and functionality because when not on the dispatch we could have two windows open side by side – excellent for creating and comparing spreadsheets and documents.

    That doesn’t really address your problem of space. Our dispatch program had the functionality to minimize columns, so we could make the program fit a 12″ screen by collapsing sections not in use and then reopening them when we wanted.

    Liked by 1 person

  2. Sigh. I keep trying to tell you that you are attuned to the wrong value system—that of doctors and staff. A good software system would accommodate you where you are, even if it is not the best place to be, and would lead you to a better place. But, that would be more expensive and would have caused the vendor to take more time in getting to the market—none of which is consistent with the values of the implementors or the decision makers.

    Liked by 1 person

      • No. You don’t need to get over it. You should always be outraged. You need to get over expecting things to be based on what is good for practicing medicine. That is no longer the objective for the organization you work for—as you often point out.

        Liked by 2 people

  3. I dislike going to the doctor, period. But what I really, really, really dislike about it is when the nurse comes in and doesn’t look at me, just starts typing on the keyboard in front of a pretty big monitor. I don’t even know if she is talking to me, to herself, or to the earpiece she wears when she does say something. There is no eye contact. Then the doctor comes in and it gets repeated all over again.

    Now I know why. 😦

    Liked by 2 people

  4. A 24-inch screen? That’s too big for sure. Most practices tote smaller laptops around. I know I did. And even then finding a place to put them can be tricky. That doesn’t make good design sense. Wonder how many physicians they had weigh in on that software development. Probably not enough.

    Liked by 1 person

  5. I have been thoroughly disappointed with technology this week. (No internet at work for over 7 days now.) So this kind of just adds to my disgust. I am sure someone has their hand in the equipment sales on this. It is ridiculous in the day and age of portable electronics that they can’t have some alternatives.

    Liked by 1 person

  6. Gah. We have this at my dr’s office and I’ve noticed his irritation. The nurses don’t seem too bothered, but our dr turns around about 20 times in 5 minutes (to look at us) while he verifies all the data in the computer. I think it’s probably not good for his neck. Now I know, it’s probably not good for his wallet, either.
    It seems obvious to me that a tablet format would be preferred. Maybe a lil less on the neck, definitely better for the wallet!

    Liked by 1 person

  7. I think the system needs to be made more fair. The patients should sit in a separate room and communicate with you via their own 24″ screen. I would think there’d be plenty of room for 2 screens in those little exam rooms, right? And then, no one is looking at anyone, so nobody feels slighted. Might work – so long as you don’t need to actually palpate anything on the patient. πŸ™‚

    Oh wait, that’s what telemedic videoconferencing (remote office visits) is all about …

    Liked by 1 person

  8. You clearly just don’t understand how AWESOME the whole thing is. That’s the trouble with doctors, you’re not techie enough. (Someone asked above how many doctors weighed in on the design process….ahahahahahahaha! right there, that shows complete lack of understanding!)

    Take out the walls between rooms. Double up patients in the now bigger rooms that are equipped with mega screens.


    I should rule the world.

    Liked by 1 person

  9. I swear people in IT are the most…. outrageous bunch.( I had a few choice words but did not use them) Save you 24 minutes of scrolling… Tell them it is your wellness workout….(another costly endeavor by many companies.) I am scratching my head at the latest stupidity we are looking at. Our IT department was presenting to management their budget results and we lamenting the cost of repairs for the laptops we use in the field. They are Tough Books, except they aren’t. IT was complaining the cost of repairs for some machines went over $800.00…… we all looked at each other…what? You could buy a brand new laptop for that. Well, it seems the jerk who WAS our IT Executive approved the purchase of these laptops at the staggering rate of $2000. each. Are you kidding me???? And they are crap. And of course they break, they are out in the field being carried in backpacks. They have no camera, no DVD or CD player. They have tiny keyboards and the screens crack from being turned to be signed. I wonder whose kick back this was. IT….. more like the clown from IT ( Stephen King reference)

    Liked by 2 people

  10. I see that people with a lot more digital experience than I have given you some leads to follow! With regard to why this is happening, I think you touched on it in one of your questions: follow the money. That will tell you why.

    Liked by 1 person

  11. I hope you get some answers to your questions. I’m just wondering, guessing, that most doctors feel the same way you do about this. What if all of you got together and said, “NO. We need smaller screens.We want tablets.” Not trying to add stress. Just wondering if that is an option.

    Liked by 1 person

      • I’m not thinking of striking, something more outside the box. Reading your posts, I feel for you. It seems like you are trapped. I have felt trapped, too. But how trapped are we, really? There has to be another way, a way around at least some of the bureaucracy. Not sure what, but a unified front, or perhaps an alternate path that will ultimately help patients, too. While that simmers in the meantime, take care of you and dream of Paris!

        Liked by 1 person

      • I tend to think and write in a weird shorthand. My grammar is pathetic in my notes. Actually, it is pretty bad in most of my writing.
        I liked the ability to draw arrows (and sometimes smiley or frowny faces in my notes.) I am THAT girl.

        Liked by 1 person

      • The shorthand was great! You could read through a note in five seconds and get what you needed. Now you have to read words and wade through that to find what it important. Takes so much longer and is so much easier to miss something.

        Liked by 1 person

      • I have noticed people add a lot of extraneous nonsense into their notes now. It is all ridiculous.
        Furthermore, Our EMR is so difficult. I find the addition of approximately a trillion ridiculous diagnosis codes a real problem.
        Instead of being able to just mention a PSH with a chole- I have to address about 10 boxes, that have no bearing on the current situation. It takes me a minute or longer to address something that should take me less than 1 second.
        On the bright side… I now know there is a real medical diagnosis of fear of hypertension.

        Liked by 1 person

  12. Ask the manager to install Windows 8, no start menu and when he or she comes back saying “I do not like this software interface!” you can say well Microsoft in its infinite know-it-all wisdom decided for you and this operating system is optimised for larger and multiple screens.

    Then ask him or her to try out Windows Vista without the patches and watch the suffering. Then save this poor soul and give restore their systems with Windows 7.

    24 inches. When the management brags about it you can say “my ruler only has twelve, more practicality.” You rule them with that one…

    Liked by 1 person

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