My brain-injured mother was admitted to a suburban hospital (recently received by the "big hospital" where her EHR-related injuries of 2010 had occurred) Saturday morning.
She was again in a confusional state (delirium) of unknown cause, maybe recurrent infection.
Of note, virtually every one time I see hospital EHRs, I observe a problem.
In my Jan. 2011 put up in this problem at the same organization, "EHR Problems? No, They're Merely Anecodotal; the Truth Must Be That I Attract Bad Electrons and Stale Bits" I viewed a nurse-stated "glitchy-ness" that day that manifested as unreliability in pulling up the patients' show day med lists. I needed to be the conduit of my mother's meds, despite having prolonged long gone through them in point for computer computer entry in the unquestionably same ED simply 24 hours earlier after a fall:
... My mother was having a repeat of the ischemia to the thoughts or "TIA" (transient ischemic attack, i.e., threatening to have a stroke), only this time the ED EHR itself was also having a TIA.
This was not the "FirstNet" ED EHR by Cerner forensically analyzed by Dr. Jon Patrick (as I wrote about here), but one different ED EHR, by a company whose ICU physiological monitoring device I once as CMIO struggled with consequently of repeated, unexplained crashing.
On this most contemporary ED visit/admission to the satellite simply days ago, I noted one different problem with the ED EHR device (the same one that started my mother's travails at the crucial facility in May 2010, and now in use at the satellite).
When the ED nurse brought up my mother's allergies, they were repeated over and over and over at the ED screen, in a prolonged recurrent list dozens of traces long, as although that that they had been cut-and-pasted dissimilar circumstances at every one visit. She apologized to me. See pictures of a printout that was bought to me by an ED attendant upon my request as my mother's POA, under (names of hospital, patient, EHR, and EHR reveal screen observe layout digitally redacted):
Allergy list, website 1 (excerpted from an on-screen continuous list). Click to enlarge.
Allergy list, website 2 (excerpted from an on-screen continuous list). Click to enlarge.
Allergy list, website 3 (excerpted from an on-screen continuous list). Click to enlarge.
Note that on-screen those appeared as a long, confusing list.
The repetition made the list near lifeless to the ED personnel (for example, they do not have time to seem for the only crucial item that ISN'T a replica in the mess).
Legible gibberish indeed.
The ED RN simply asked me about my mother's allergies, saying she might not make really sense of the computer computer list and needed to make sure no mistakes occurred. This is an appropriate attitude - the only appropriate attitude - for a clinician. Fortunately, I'm a doctor and know the bronchial bronchial bronchial asthma well.
The hospitalist then recognized as me that evening time suggesting she might provide my mother Levaquin, an antibiotic. For the umpteenth time I needed to tell a doctor at those facilities my mother was allergic to Levaquin. This was in truth indeed considered one of my complaints on my April 2010 warning letter to the hospital's CEO and CMO on EHR deficiencies I'd noted in my mother's care. This was simply one month prior to her catastrophe, whereas a severe coronary heart medicine "disappeared" in the ED EHR, causing a cascade of medicine continuity failure.
Yesterday I insisted the duplicate entries be removed (more precisely, "made inactive" - they still appear, but in a different color than "active" entries).
It is, on first principles, inherently risky to the public to have severe affected user book stored in disarray in an Emergency Room electronic effectively being record.
See the above images, and ask if it's what you'd want busy ED medical doctors to ought to wade through to check out if a drug they're about to administer might injure or kill you.
Post legal-threat addendum:
I'd originally posted actual reveal screen observe pictures (PHI and hospital title redacted) of the allergy lists bought to me by an ED attendant upon my request as my mother's POA.
On April 8, 2011, however, I received a threatening letter from the accredited skilled representing the hospital claiming those shows were viewed by the consumer as "copyrighted and proprietary information" that I had "misappropriated" (stolen).
(This raises the question as to who, exactly, the "client" is - the hospital, or the EHR vendor?)
In any case, I was asked to "retract from the blog the copyrighted and proprietary information" under threat of the hospital "pursuing all remedies under the state's trade thriller accredited suggestions and Federal Law." Further, I was accused of "inappropriate behavior" in making an try to shield my mother from more EHR-related accidents.
The allegations (actually, fabrications) of "medical information misappropriation" and "inappropriate behavior" were fairly outrageous and unprofessional, on the grounds that the hospital had already altered my mother's medical file by adding the medicine they missed to the ICU H&P as at this post, was caught at it, and had admitted it to me.
I have now accomplished as asked, only posting the allergy information and dates without the ancient earlier EHR tabs of the reveal screen observe header, the only component that might even remotely be viewed as included IP (i.e., of the EHR vendor).
I had a followup discussion with a senior nurse involved in the EMR project about those shows and the accredited threats, which I viewed as energy retaliation aimed towards discriminatorily denying my mother and I use of public accommodations, i.e., the hospital, through intimidation. (If my looking for information legitimately was "inappropriate behavior", who knew what else I might be falsely accused of to "discourage" my return?)
I was advised with a at this time face that the allergy repetition was a "feature", not a bug.
The problem was "the nurse in the ED", who did not recognize they needed to "look at the dates" to recognize the allergy list. ["Blame the user" is typical in this aspect - ed.] This senior nurse fully had an amateur's understanding of HCI and clarity of presentation of information - or was simply talking down to me.
I bought a reminder that with 20 years of Ivy academic, vast hospital (much increased than hers) and Big Pharma ride in this domain, I found her arguments specious.
Amateurism on presentation of information is a factor that promotes EHR-related error. (It is my want the distinctive ED nurse is not punished for holding patients particularly of "protecting the computer" and its faults.)
Thank You and Good article Saving My Mother Yet Again. EHR Legible Gibberish - Another Example, the ED EHR Allergy List - And Legal Threats for Exposing Problems this time, hopefully can benefit for you all. see you in other article postings.
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