As I walk on to the floor of any hospital to see my ill patients, the search begins. If I am lucky, the patient’s chart that I need to review and write in will be in the correct spot in the chart rack. However, more often than not it, there will be an empty space — and then the hunt begins. First, I will look at the secretary’s desk to see if it is there awaiting orders, or perhaps another doctor has it in a back room, or a case manager (formerly known as a social worker or discharge planner). If not there, then maybe a medical student or resident has it.
If it is still missing, in frustration I will finally ask a nurse to help me locate it. Names are no longer on the chart — privacy violation — making the task even harder. Sometimes they can’t find it either, and then I will finally go to the patient’s room. This is important since if the patient is in their room, the chart is somewhere on the floor, and the Easter egg-like hunt resumes. If they are gone, for example to the x-ray department, then the chart is most likely with them.
Last month in this column, I lamented about the antiquated system of paper charts that still has most hospitals and physicians enslaved. Change is never easy. And doctors as a rule are stubborn, so we fight the switch to the electronic health record (EHR) with all manners of gusto and conviction.
The EHR will happen no matter how much we wail or mourn for the past. Part of the problem, which makes the healthcare system so difficult to modernize to an e-record, is that there are so many separate but interdependent parts: doctors, hospitals, patients, insurance companies, pharmacies, durable medical good suppliers, etc. And then there are the always-tricky privacy concerns. Yet, these are solvable obstacles and should not be seen as insurmountable.
Here are a few of my suggestions:
• E-vendors need to do a better job of compatibility — records must be able to “talk” to each other.
• Hospitals should hire doctors to mentor their technologically-challenged colleagues.
• Set up realistic steps and timeframes, so the e-record is gradually phased in.
• Make sure there are enough working computers in all areas of the hospital.
• Seek input from nursing, secretarial, and physician staffs before foisting a cumbersome system upon them.
• After implementation dates, have technical staff readily available, even roving the halls, to help everyone.
It has been said that change is the only constant in life. The EHR will come eventually, whether we like it or not. And as for me, I for can’t wait, because a good portion of my day in the hospital tomorrow will be hunting for charts — again.
Find out more about David Mokotoff and our other Practice Notes bloggers.
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy