Saturday, August 15, 2009


Today was the first Saturday I've worked since the new electronic medical record system went live.

Gone are the days of physically reviewing a medical record, sifting through the orders, writing a note in the chart to say that I'd started an eval, handwriting the eval, jotting a quick note to the primary therapist to tell her how the patient did, and writing a simple code and number on a graphics sheet that matches the paper bill. Now we carry funny little laptops about that "autorun" templates and magically drop our bills. It's weird.

I'd gotten pretty good at getting a lot written during an eval or a treatment session without it interfering with the patient care - when the patient was engaged in something, reading something, or simply looking away I'd be scribbling in the details to fill in the blanks. As soon as the patient was done I could just look up and stop writing. I didn't need a table top. Now I've got this awkward little computer to tap on, and frankly, there just simply isn't enough time in the day to not be documenting on what I can during the treatment session.

The biggest concern I have is not how inefficient I've become but what the presence of that little computer may do to the patient's treatment experience. Paper charts are a long standing expectation of a patient in a medical setting, but the electronic version of the same activity marks a new era that may make the bulk of the population that I see uncomfortable.

The current culture of multitasking with our electronics and blurred lines between work and personal tasks is seeping into areas that were once held sacred. My church has recently been having an internal struggle with using the word "church" vs. "community", a word the "unchurched" may find more appealing and comfortable, and whether or not offering coffee before worship that can be taken in to the sanctuary is an act of hospitality or pandering to those who can't be bothered to wait an hour before their caffeine fix. In talking about this I was telling my mom that I often bring my cup of coffee with me into my 8:00 a.m. appointment if I haven't finished it yet if I ask the patient's comfort with it, and in her opinion it implied that I wasn't paying full attention. But I am, I said. But it wouldn't look like it, she said. Hmmm. But I want to finish my coffee and I usually have a thousand things to do from 7:30 - 8:00 and don't always get to it. Convenience for me, please.

I did a couple of evaluations and a couple of treatment sessions with my little puter today, and for the first few I pulled up a table and tapped away during the session. In the afternoon, though, the sweet thing that I was evaluating was confused and needed someone sitting close to her talking softly, and the next one was a lady with a seizure-riddled brain who kept trying to take my computer and everything else in reach, including using an alcohol wipe like a pepper packet and trying to sprinkle it over the table top. My group of 5 who were trying to play bingo and not succeeding had me sweating. No time for typing.

At the end of the day, it always comes down to what the patient needs vs. what I need to not have an extra couple of hours for documentation tacked on to my day - my need for convenience shouldn't get in the way with establishing rapport and trust. It's going to take some creativity and careful planning to have time to get it all done, especially when the electronic record goes live for the outpatient network (just in time for the holidays...awesome).

The good news, for those who share my mom's opinion, is that I can't carry both my laptop and a cup of coffee with all the other stuff I have at any given moment.

The image is from here.

No comments: