Our hospital is installing an electronic medical record system (EMR). It has added a minimum of 15 minutes to the time it takes to process each patient, without a perceptible increase in quality of care.
The Trouble with ICD-9
One benefit of the EMR, however, is it is showing me now inadequate ICD-9 is. For example, if I code “congenital heart block," ICD-9 does not allow me to specify whether it is the mother or fetus that has the condition! Nine tries and they still haven't figured that out. And if a patient has an abnormal screen for Down's, ICD-9 does not let me specify whether the fetus has a known or suspected chromosome abnormality. I hope ICD-10 is better, but I am not holding my breath.
"Meaningful Use" reporting?
Here is the kicker. Today I saw a patient report that our system prints out. Problem was, the left 11/2 inches of the report is missing, and the right 11/2 inches of the report is just blank. In other words, they are left-shifting the image on the report 11/2 inches (and losing the left 1½ inches) before the report is printed.
So I tell the EMR guy that this is a piece of crap. He says that this is OK since the report is shredded as soon as it is printed, so nobody has to worry about the error. Anyway, they are working to fix it.
I ask the EMR guy, "If we are printing the report then why we then shredding it immediately after printing? Can't we just skip printing the report and save a tree?"
He says this is impossible. "We MUST print the report."
I ask why.
He says that the report is proof of "meaningful use," and it has to be printed within 72 hours of seeing the patient. Otherwise the EMR is NOT being meaningfully used, and the government will penalize us.
I say, "But we shred the report. We destroy it."
His reply: "Your point is ???"
"My point is, if we shred the report as soon as it is printed, why not just SAY that we printed the report and that we then shredded it and that way we will NOT kill a tree?"
"Because that would not be meaningful use. We have to print it."
But do not fret. They are working on a way to print the report to a PDF file that will then be erased. Printed and erased, but no killing of trees, just one mild and temporary abuse of the surface of the hard drive.
Back to my original problem. The report is still missing the left-most 1½ inches. Not to worry, however. They will fix that printing glitch so that the PDF file that is deleted is, at least, correct before it is deleted.
Boy, I sure feel better now.
Can you say, "Catch 22?"