Learning to Fly

Our facility just rolled out a shiny new electronic medical record and computerized order entry system this week. Emergency physicians are now encouraged (well, forced) to order all laboratory tests, X-rays, and medications electronically, via drop-down menus on computer screens. And of course all patient charts are created with a keyboard and touchscreens too. The paper system which had served us well for so many years is now officially extinct.

Although we were trained how to use the new system, it's difficult to learn the intricacies of something like that until you are actually in the hot seat. I initially found it very difficult to concentrate on patient care while I became accustomed to the new system. When you have to spend an extra 10 minutes trying to figure out how to order a suture kit, for example, that's 10 minutes you aren't spending thinking about your patients.

I liken it to trying to fly a plane with which one is unfamiliar: a pilot trained to fly piston-powered airplanes transitioning to light jets for example. You can train on a fllght simulator for weeks but still not be able to open the door to the jet when you try to board the real thing. And while you know how to fly a plane, you might not know how to lower the landing gear on THIS particular plane. So the possibility of a crash is increased.

Little quirks in the system were both frustrating and amusing. A urine pregnancy test was inadvertently added to the urinalysis of an elderly gentleman (thankfully, it was negative). A patient was accidentally discharged from the system, and it took us 15 minutes before we could figure out how to find and replace the electronic record so that we could resume charting and writing orders.

A simple x-ray cannot be ordered without answering multiple drop-down questions:

1) is the patient allergic to iodine? (no, but I'm not giving any iodinated contrast; it's a foot X-ray)
2) does the patient have a working IV? (no, but he doesn't need one; it's only a foot X-ray, dammit!!)
3) did the patient drink contrast? (no, does any patient EVER drink contrast for an X-ray of a stubbed toe? AAARRRGH!!!)

We also get lots of WARNING ALERTS like this:

1) The pain level for this patient (1/10) is severely above normal!!!!!
2) The systolic blood pressure for this patient (139) is severely above normal!!!!!
3) Severe drug interaction!!!!!!! (if we give a dose of Toradol in the ED and then discharge the patient on Motrin, for example)

How did we let this happen? Shock the monkey!