Thoughts from reading

So far I've found the most interesting stuff in chapter 2.  It's all about data.  I'll just go through the chapter and give my comments about different sections.

What are medical data?

This section looked like it would be not very helpful, but it actually got me thinking about the different aspects of data, and what I usually automatically do with it.  For example, one of the questions after the chapter asks you what it would mean if your pulse were 100.  It can mean many different things, depending on the situation.  If I had just ran to catch up with my favorite ice cream truck, it would be a normal response to increased exertion.  If I were a pediatric patient, it could just be normal physiology.  If I were losing blood, it could be a sign on intravascular volume loss.  This type of thinking is helpful on wards.  When I analyze the vital signs, I should do more than just check if they are in the normal range.  Sometimes if they are in the "normal range" they aren't necessarily normal.  And I can think about the patient's condition beforehand, and then look for certain changes in the vital signs that could be a signal of pathology.  

Another part of the chapter talks about how medical terminology isn't standardized, and how it would be helpful if it were.   If the computer knows what the information actually means, it can perform tasks to learn more about the patient, or to survey patient charts, being very useful in research.  However, like I said in the previous paragraph, medical data are more than just a number.  They change depending on the situation and the patient.  This might be one of the reasons medical terminology is not standardized, yet.  It is complex and conditional.  If a program searches for all the patients with "hypertension" it would need many conditional statements to get the information that the researcher needs.  

Another part of the chapter has an interesting statement: "it is crucial that they do not trust their memory when caring for patients."  I've actually received conflicting training on this.  One of my medicine residents said that we should have our patients in memory, and that we should be able to present them without any notes.  Later, an attending taught me that it is foolish to do this, and that things can be forgotten so easily, which could result in errors.  I think there are things that are useful from knowing your patients from memory, though, even if you don't solely rely on our memory for decision making.  I should know my patients well, and not just rely on the chart to tell me everything.  When I do this, I can think about the patient and the disease process even when I am away from the chart.  

I was especially in accordance with the section on "Weaknesses of the Traditional Medical Record System".  As I posted before, with the capabilities we have today, computerized records provide so much more to the patients.  It's not that the doctor is lazy and doesn't want to flip through a few pages.  The charts can get huge, making it very difficult to find what your looking for.  Additionally, probably every time I've used a paper chart, I've had parts that I couldn't read.  That is not good medicine, and not good for the patient.  If it is not legible, it's like it was not written.  

All in all, this chapter got me thinking differently about the data I use and interpret.  It also gave me some ammo for convincing people that paper records are insane.

Why I Took This Course

When we met with Dr. Miller for our first session, she said that we probably took this course for one of two reasons: either we were bored and looking for something to do, or we were interested in health informatics.  Well, in this post I will try to convince you that I am taking the elective because I am interested in health informatics.

I've always been interested by things technologic.  I even admit that I've been an early adopter of gadgets before they were sensible to use (In 2001, I bought a $200 cd player that played cd's with mp3s on them, and then I only used it with regular audio cds).  Naturally, in medicine I look for ways that technology can help me in what I try to do.  I remember the first time I tried to use a paper chart.  I couldn't find a thing.  My preceptor had to show me that it had tabs and that each tab had different types information.  I was amazed at how foreign even that was.  I was more perplexed when I tried to read the darn thing.  I couldn't make much out.  In my third year of med school I was expected to use paper charts on a daily basis in outpatient clinics.  I was even more appalled.  I tried to research the patients past medical history, look up labs, try to make sense out of everyone's handwriting.  I remarked many times that using paper charts is insane.  I would have to say I still agree.  Even in Cerner, looking up a patient's history and labs is relatively simple (though I have ideas that I think would make it much simpler).

I remember on my Surg Onc rotation we had to present the 20-ish patients to the attending and residents before clinic.  It was the duty of us four medical students to research them the night before and come up with some coherent ramblings to present the next day.  This task was formidable, but helped me get used to researching a patient's history in Cerner.  I had to sift through the notes to find the information.  For the first couple of times, I didn't even know that I could organize the notes by provider or service instead of just date.  But even with the help of a computing system to organize the notes, it still seems like something is lacking, like it's not as easy as it could be.

So, the reason I am taking this course is to learn about this beast (EMR) that I will be using for the rest of my life.  I want to learn how all the different aspects of it work.  How the parts communicate with eachother.  I've seen some other hospital systems and I admit that I'm impressed with how complete VCUHS's is.  I'm interested in data entry.  In physician templates and how to make them work better.  I'm interested in electronic sign-outs and how to make the it as seamless as it can be.  I see the advances that are being made with mobile computing with smart phones and tablets.  I want to learn how they can be used to make workflow better and quicker.

The bottom line of why we use electronic medical records, though, is not because it's cool and we may get to carry around an iPad.  It's the potential safety and benefits to the patients that potentially lie in the proper implementation of a whole EMR system.  It's interesting that sometimes the implementation process initially hurts the patient safety, but EMRs must be implemented for the long-term benefit.

I look forward to the day when I will be able to pull up any patients complete past medical history.  Then health care will be able to provide complete service to patients, with many fewer patients and facts and charts falling through the cracks.