Are electronic medical records killing and injuring people?
"Without a doubt," says John Sotos, MD, in a recent Wall Street Journal blog.
Dr. Sotos, a cardiologist, flight surgeon and former medical technical adviser on the TV series "House," describes the "true tale" of a patient he calls Alex, whose IV fluid orders, he says, were botched 3 times in 3 days. The culprit, says Dr. Sotos: inattention caused by EMRs.
Alex, he explains, wasn't supposed to eat or drink on Day 1 of her hospital stay, but the staff failed to order fluids for her. Then, on Day 2, they gave her 3 times the IV fluid she needed (forcing her to use a bedpan every 20 minutes and resulting in "brisk bleeding around the catheter sites"). On Day 3, when she again couldn't drink, staff again failed to order IV fluids.
How could this series of missteps have occurred? Nurses today, he says, are "almost literally, chained to a computer station (that) goes with them from patient-room to patient-room." A task like documenting urination requires numerous steps, he says: signing on to the EMR, grasping the mouse, selecting the patient, clicking the urination tab, moving hands to the keyboard, typing the volume of urine and, finally, clicking save.
Before EMRs, he says, such a chore took 4 to 6 seconds: "A nurse would lift the clipboard hanging at the foot of the bed, grasp a pen hanging around his or her neck, write the time and the volume of urine produced, then rehang the clipboard."
In Alex's case, 3 nurses on 3 wards missed all 3 mistakes because they were forced to pay too much attention to the EMR and not enough to Alex, he argues. "I cannot imagine the sharp-eyed university nurses of 20 years ago letting me make these errors," he says. "Detecting Alex's fluid mismanagement required only a glance at her, a glance at the IV pole next to her, and a modicum of thought. Obviously, the glances and thought didn't happen.
"EMR proponents argue that presenting timely, complete information … more than offsets any cost in attention," he continues. "I doubt it."
The onus, he says, should be on EMR vendors. "(They) must realize that the human-computer interface … must be designed to be undemanding of attention and cognition."
What do you think?
