As health care reform rumbles along, it has become increasingly clear that electronic health records (EHRs) are here to stay. I dare say, most of us are relatively happy that the change has come: notes are legible, information moves quickly, communication channels between doctor and patient are improved, and work flows streamlined.
Well, not always.
Take the example of the work flow required to process a simple office-based EKG:
- Enter an order for an EKG
- perform the EKG
- A doctor edits, interprets and signs the computer-interpreted paper EKG
- EKG and it’s edits are loaded on the central EKG server
- the results are electronically "signed" by the doctor on central EKG server to it can get posted as "final" on the EHR
- A notice appears in the doctor’s EHR results in-box notifying him that a new EKG result is available for review.
- Ideally, the doctor attaches a "result note" explaining the results to the patient and the result forwarded to the patient electronically.
- Except many patients don’t use a computer
- So the patient is called and another hand-typed electronic telephone note added to the patient’s electronic health record to document that the patient was informed of the result.
All of this time, energy, effort, for a single EKG.
Now, multiple that by ten EKG’s, three echos, two chest-xrays, and a partridge in a pear tree that gets ordered on our patients each day and you’ve just created "result bloat" for doctors.
When a single test result must be "resulted" three or more times by the attending physician because of constraints of conjoined information technologies, not only do we demonstrate meaningful use of our electronic medical records, but we also demonstrate meaningful abuse of our doctors’ and support staffs’ precious time.
First we saw "note bloat."
Now we’re seeing "result bloat."
Washington, are you listening?