EHRs can be great. But they are not perfect. While they convey facts very well, they often miss out on the bigger story behind the facts. Sometimes, nurses have to end up checking boxes that don't totally fit the situation. Is that lying? Share your thoughts!
The nurse looked up to the wall where the digital clock from a bygone era registered 7:55. He felt the combination frustration and total despair rising up in his throat as he tried to record all of what he had done since 7 a.m. —ages ago now, it seemed. He clicked through the electronic health record (EHR) steadily trying to reproduce his day accurately through a series of clicks on boxes that didn’t at all fit the events.
Consciously slowing down so as not to make any accidental errors which could result in even more delays, he tried his best to find ways to use clicks to describe a narrative of a day gone bad: there was the patient that crashed, several that needed their pain medications adjusted, and, of course, the admission and the discharge. All of this activity resulted in literally thousands of clicks through well-worn screens of the now-familiar, but ever-cumbersome EHR.
Reality Doesn't Match Rosy Dream
The nurse remembered back not even 20 years ago when computer records held forth so much promise: they would be better, more efficient, and certainly involve fewer errors with record keeping. Reality simply didn’t seem to match the rosy dream. The electronic world has indeed brought forth a new era in medicine but along with it, some unpleasant side-effects that can make them a bitter pill to swallow.
How often do you find yourself clicking choices without matching what you really want to say?
The scenario above may sound all too familiar to today’s health professionals who work hard every day only to find themselves unable to accurately transcribe into an EHR what they have seen and done in a way that is easy for others to follow. Not only that, by “sort of” being able to click through choices without truly matching what they want to say, the nurse or other professional may find themselves in the uncomfortable position—and sometimes unethical position—of feeling like they might be telling a “sort of” lie. It is appalling to think about, and many would probably deny that it happens, but those in the field know all too well the feeling of not having the choices they need to click on within the EHR.
Practitioners are sometimes asked to populate templates that may include items they didn’t have time to thoroughly check, thereby creating a half-truth that leaves the conscientious nurse uneasy and unable to feel like he/she did a great job. By repeatedly subjecting ourselves to this need to click on or populate parameters that aren’t totally true, it is possible that eventually a certain numbness develops, taking excellence and pride right out the door with it. It is ironic that in the search for accuracy and perfection, modern electronic health records create a climate that fosters instead, more half-truths and whole lies.
Lots and Lots of Facts, But, Lousy Patient Story
Besides pushing nurses into difficult ethical territory, another unintended consequence of EHRs is their inability to tell a story well. They do a superb job of remembering facts—lots and lots of facts—but they do a lousy job of telling a good, solid, complete patient story. How many times do patients have to parade through the exact same questions over and over again? How many times does the story of their medical history get totally lost in the avalanche of clicks and the paper-work it produces? How many times does what happened yesterday with their pain or their constipation or their access line or their family member get lost into clicks many screens ago, and become, in practical terms, irretrievable? How many times do nurses find themselves asking the patients what happened to them since you last saw them? The puzzled looks from our patients should tell us something as they furrow their brows seeming to wonder, “Can I trust these people to care for me?”
How many times do we tell families not to leave loved ones alone at our hospitals anymore because we can’t know for sure that one shift will have the ability to communicate with the other that Momma has dementia or that Daddy always gets dizzy after he takes a pain pill? Our patients’ stories sometimes get swallowed whole by the EHR, making the daily chore of sharing their physical current events paradoxically much harder than it should be.
Lack of Cohesiveness and Communication Between EHR Systems
Our current system of EHRs is fractured and fragmented. While some individual systems are good, there is a lack of cohesiveness and communication between systems so that going from one doctor to another or one town to another poses a good deal of risk. A simple transfer from a hospital to a long term care facility can be fraught with danger for fragile patients. Poor information transfer can result in myriad health complications including medication errors, falls and re-hospitalization.
It is true that there are some outrageously good EMRs out there and despite the many problems, computers do keep accurate records of what we put in them; they know how to spell; they don’t have messy handwriting; they can scan a barcode like nobody’s business; they never get mixed up on a name. However, they do have a really hard time telling a good, accurate story, and sometimes in our quest for perfection and our great desire to eliminate even the remote possibility of a lawsuit, we ask our programmers to design EHRs that take us all to the edge of craziness, pushing professional nurses into a daily corner of half-truths or is it lies?
I never lie about medications, procedures, assessments, etc. I do fudge about "mandatory hourly rounding". I mean, really? The entire staff is running their understaffed butts off, no one has time for the 5-10 minute friendly conversation that makes a patient feel like they're in a nice hotel. And here's the math. Hourly rounding 5-10 minutes per patient x 5 to 6 patients= 25 to 60 minutes per hour. Now the variables are broad, but the max time spent is impossible. And yes, I know that "rounding" can happen during care, but the idea from management is that happy one-on-one special time.
I never lie about medications, procedures, assessments, etc. I do fudge about "mandatory hourly rounding". I mean, really? The entire staff is running their understaffed butts off, no one has time for the 5-10 minute friendly conversation that makes a patient feel like they're in a nice hotel. And here's the math. Hourly rounding 5-10 minutes per patient x 5 to 6 patients= 25 to 60 minutes per hour. Now the variables are broad, but the max time spent is impossible. And yes, I know that "rounding" can happen during care, but the idea from management is that happy one-on-one special time.
dracarys bsn, BSN, RN
21 Posts
The bolded is not really true. If your EHR is demanding you to document something, it came from your leadership for it to be built that way.
I'm an Epic analyst. Epic doesn't recommend very many hard stops at all, but hospital administration wants hard stops for everything.