Epic Fail

One thing that revolutionize the practice of medicine in the past few decades was the introduction of electronic medical records (EMR). They became nearly universal during the 2010’s. This replaced the physical paper charts and files with digital systems. That was the death of paper and pen for us (see previous post).

For me who started with paper charts when I began my practice and then learning to adapt to full electronic records was not all easy. I would be lying if I say that I did not struggle in the beginning. I have an older partner who chose to retire rather than deal with it. Retiring was not an option for me, as my kids were still too young then.

But I embraced the change and I admit, it has definitely improved they way we practice. For one, it made administration of drugs faster – from the time the physician wrote the order (or ‘clicked’ on the computer), to the actual time the patient received the medication, especially in hospitalized patients. It also improved patient’s safety as no more medical error just because the nurse or the pharmacist cannot read the doctor’s handwriting that is akin to a chicken scratch. This also enabled faster sharing of medical histories and even medical imaging across different providers.

Once we got used to the electronic system, it also made it easier for us to manage patients. For example, if we have a patient that we are admitting for pneumonia, we just click open the “Pneumonia Order Set” and boom! The orders are populated – including the preferred antibiotics, with the right dose and frequency of administration, the recommended labs and tests, the associated orders like diet, vitals monitoring, and other items like fever medications, and even for constipation and bowel regimen. It is as easy as ordering food and a drink from a touch screen kiosk.

I have also become adept in typing my admission or progress notes, or more so in dictating them by using my “dragon,” a medical dictation software. Yes, I did train my dragon to understand my Filipino accent and diction, plus the nuances of the terms and vocabulary I usually use. Though there are some doctors in the hospital that rounds with a medical scribe (a real person) who types their notes for them. If kings and high-ranking officials employ scribes in the past, why not doctors today, right?

It would be nice if there is only one electronic record brand or software for all hospitals and clinics. But no, different health care systems have their own preferred medical record brand. For example, one of the hospitals we go to uses “Epic,” while another hospital uses “Cerner.” Then in our clinic we use “Allscripts.” Needless to say, I have to learn all of these systems. Maybe someday there will be one unifying system, perhaps when I retire.

A few days ago, something dreadful happened. While I was working in the hospital, Epic, the electronic medical record system, went down. And it was down for a few hours. I heard that the disruption was attributed to a general network and system-wide technical outage. Was it a software failure? Or a cyberattack? Who knows? Makes me wonder, are we that vulnerable?

While the computer system was down, the physicians, nurses, and other hospital personnels cannot do any work. Doctors cannot put orders in the chart. Nurses cannot do their charting. Administration of medications were disrupted, as the Pyxis – the medication-dispensing system that interface with the electronic record cannot be opened. Some surgery were delayed. Patients cannot be admitted or discharged. Even the simple viewing of laboratory results or x-rays cannot be done. In fact, the hospital went into a temporary diversion, as they cannot accept and treat patients in the Emergency Department without electronic medical records. What a mess!

I guess we cannot practice medicine now without the use of computers. Sad but true.

I envy the traditional hilot in the Philippines, who does not have to use computer system to practice their healing touch. Or are they using them too?