Tuesday, March 27, 2012

Croation? How about we pick English?

A friendly ophthalmologist who works in a number of facilities informs me that different and proprietary IT systems are killing him in several ways:

First, every time he goes to a new hospital he has to learn that hospital's variation of IT - even if they are using the same vendor, such as Epic.

Also, it takes him much longer to document stuff in the computer than it did on paper.

Third, the systems are constructed to satisfy Medicare rules and meaningful use requirements, so the doctor finds himself having to ask each patient if s/he has ever smoked, even though he doesn't care from his specialty's point of view.  Never mind that, in a proper record, the answer would already be there! 

The funniest thing he said was he has to ask each patient in what language s/he would prefer to conduct the visit. One lady answered, "Croatian." The doctor said, "That's not on the list.  How about we pick English?"


Brad F said...

Why cant a specialist ask about smoking? Has the purview of preventative measures gotten so "pedestrian" that the "other docs" only do that stuff.

Ever hear of diabetic retinopathy? Smoking sure does not help.

I will give on the IT absolutely, but in making one point, you demonstrate another--exactly where our system is broken. Silo'd thinking.


Paul Levy said...

Not necessarily an indication of silos, I think. Sometimes, some questions are just not apt.

Paul Levy said...

But, you are certainly right about the silo tendency!

Susan Shaw said...

I'm with Brad on this one. Just a few short words from a doctor have been shown through a Cochrane Review to be highly influential on smoking cessation rates. And quitting smoking is one of the best things a patient can do for his/her overall health. So we should maximize each opportunity we have to actually impact our patient's health even when it doesn't seem directly relevant to the problem at hand. Patients don't come to see me about their smoking but I can still add this in to each and every encounter:

"Do you smoke? You need to think about stopping. Here's a brochure/website/phone line that can help you. How else can I help you today..."


Paul Levy said...

Ok, but shouldn't that smoking habit show up on the electronic record already?

Susan Shaw said...

Yes. So the question is why are you asking the question.

To just tick off a box to meet a compliance standard. Or to make the most of an opportunity to have a bit of positive influence on our patient's life.

And what if they started smoking in the interval since the record was last updated... I am not at all advocating for sticking with redundant questions or not trusting the information already added into an EHR. But sometimes you need to re-ask. Allergy status is another such question.

So... "I see here that you still smoke...." or "since I last saw you, have you started smoking?"

But your colleagues's frustration with the variation across different electronic systems is absolutely valid. As Brent James might say, variation is the root of poor quality and poor experiences for patients and providers.