I know it's been a while since my last post. I started off good, but then I was only home two days these past two weeks. But that doesn't really matter. What does, is that I'm here, now, writing an epic review of my thought from the past few meetings.
On Nov 30 we met with Dr. McKenna. What he said at the beginning was interesting. He said that he didn't know much about electronic medical records when he started. But he saw a need, and wanted to put his efforts behind it due tot he importance of a EMRs. I remember Dr. Miller saying something similar. I think it's great that people who aren't already familiar with the field come into it. They can bring a fresh perspective and give vital feedback and ideas as to how the normal user experiences the product.
Maybe one of the problems with EMRs is they were initially developed by people who maybe weren't focusing on the user experience, but just making sure it had all the content. I guess I have to be careful in saying that, though. The pioneers of EMRs had little precedence to go on. So it's hard to criticize them for making it much like a paper chart, only electronic. It might be the job of second-generation users to get in there and make some fundamental changes that truly use the power of being able to step away from the paper chart.
Back to our meeting. He also talked a lot about implementing the Asthma Action Plan. It's a patient education document that should be given to all patients hospitalized for asthma. Compliance has been a bit of a problem, so he set about looking for a reminder in Cerner to prompt the physician to give a plan to the patient. We talked about where in the workflow the prompt would come from, what exactly the prompt should say, how it should be tracked.
We also talked about alert fatigue. That's the thing that really caught my attention. I use a computer hours a day. And I know all about alert fatigue. That's one of the reasons I prefer the Apple computers, they have fewer superfluous alerts that pop up (though when you start adding too much third-party software, those nasty alerts start creeping in). For me, an alert needs to first off be pertinent. Nothing is worse that an alert that looks important, but you do nothing about it, and you are still able to do what you wanted to do in the first place. Like the alerts that pop up while you're navigating to the folder where Cerner is located. The alert looks like some important feature is missing, but you can just cancel it and continue on. This poor, inane, use of alerts is why we have problems with people not using alerts.
Once an alert is pertinent, it needs to be written in a way that is quick and easy to discern what needs to be done. The example of Dr. McKenna's Asthma Action Plan alerts was something like this:
"The patient was admitted for asthma exacerbation. Because of this, the patient needs to be provided with an Asthma Action Plan.
Please provide the patient with an Asthma Action Plan."
Well, it is something like that. I think this alert is definitely pertinent. And it was written much better than I have recreated it. But I wonder if there might be a way to word it that would be quicker to read, only giving the user the reminder needed. The user knows the patient was admitted for asthma, and the user knows that an Action Plan needs to be provided, the user just needs a reminder. Maybe a good way of writing the alert would be this:
Don't forget:
-Asthma Action Plan
This boils the alert down to just the essential purpose of reminding, not teaching. It is very quick to read and know what is needed.
In addition to this, maybe there could be a standard alert that comes up during the discharge process at the same place in the workflow with every patient. So the user is expecting it. And the alert just adds things to the "Don't forget" list. It could be:
Don't forget:
-Asthma Action Plan
-Add asthma to patient's Problem List
Something like that. Again, this alert should only contain pertinent information that adapts to what is actually needed. If every time it tells you to add asthma to the Problem List, even if it was already performed, then the alerts loses credibility.
Anyways, there are some thoughts from meeting with Dr. McKenna. Tune in next time for my thoughts on meeting with Dr. Wolver.
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