Hospital’s Electronic Health Record to Be Replaced by New, Efficient “Paper Chart” System

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NEW YORK, NY – Citing slow load times, confusing menu structure, and overall frustration with the user interface, St. Barnaby’s Hospital has announced that the old electronic health record (EHR) will be replaced with a new state of the art binder-based system, in which a so-called “paper chart” is kept for each patient.

No load time, Everything is right here!
No load time, Everything is right here!

The new system, brainchild of prominent New York internist Dr. Brent Shelby, was developed to improve efficiency of workflow on the wards and to cut down on the burden of useless autopopulated information that currently makes up approximately 95% of every clinical note in the EHR.

“I found that I was spending up to 30 minutes trying to cut and paste together a decent medical history from twelve different outpatient encounters in the EHR,” stated Dr. Shelby as he scrolled through a typical patient’s medical record.

“Take this consult note for example.  It’s nothing but a negative allergy history, a list of expired medications, and a religious preference.  I don’t think the doc actually wrote anything.”

According to Dr. Shelby, the chart will provide instantaneous access for ordering medications, an improvement on the approximately 15 minutes it currently takes to log in, pull up a patient by searching the floor census, accessing the current visit, searching the order database, entering the order, selecting a dose range, selecting an administration time and stop date, submitting the order, approving the allergy override, clicking Yes to “Are you sure?,” and finally a 20-second period of waiting for the hourglass to vanish.

In contrast, with the new system, a physician will open the chart and write “Tylenol 500 mg PO now,” close the chart, and place a flag up to indicate an order has been placed.

So far, nursing and residents have been very pleased with the new system.

“Well, I don’t need to go up to the neurosurg call room any more to use the one computer that works,” said intern Jeb Kowalski.  “Plus, it takes less time to physically copy from yesterday’s note than it does to cut and paste in that slow-ass EHR.”

Floor nurse Jennifer Wilks agreed: “Yes, now there’s no electronic evidence that I didn’t follow a stupid order from that moron intern Kowalski.  I just rip out the page of orders I don’t like and no one ever knows.  It’s awesome.”

At press time, several physicians we observed were throwing their office computers out the window and dancing ecstatically in the hallway.

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  • sdsue

    I am a retired Respiratory Therapist. Lucky to be able to get out when the computer had all of my patients therapy due at 8, 12 and 4. Well, I can’t do 8 treatments at one time especially if there was more than one procedure so the computer would red flag me for them being late. I never could get the hang of it and was not trained to care for multiple patients in different rooms on different floors at the same time. The following shift never asked when the last treatment had been done, they would just start again on the 8,12,4 schedule!

  • Brad Barnhill

    Wasnt personally attacking you so “read for comprehension”. I was merely suggesting you help solve the problem and not continue down the path of suggesting going back to the same broken methods used in the 60s. I do use that mentality to write code (clinically useful and safe). Again you didnt read. If your point is to come on here and attack all EMRs as “the devil” your point has been made … its just an irrational, invalid and useless point. As a consumer of healthcare I would like to know our physicians (or at least the good ones) also would like it to be safer than it was before EMRs. Have you read “To Err is Human”? It seems like it was an unsafe environment for those 98000 people a year.

  • DrJKH

    Brad, save the personal attacks and learn to read for comprehension. If you’re writing EMR software with that mentality, no wonder it’s problematic. Thanks for unintentionally proving my point.

  • Brad Barnhill

    Wow lots of blame and no suggestion on any fixes … way to show professionalism. Im an RN and Software Engineer and I fight every day to make sure what I write and what goes into our solution is clinically useful and safe. Some people are just resistant to change and electronically creating orders may not be pen and ‘chicken scratch’ like you like but its much safer. Ill continue striving to improve the quality of our solution and get you back to your patients faster, if you will try to stop preaching doom and gloom and be a team player. CP “hit the nail on the head”, except it not being either sides responsibility. I try to keep one foot on both sides of the fence to make sure I know the WHY in what Im writing. I wish some of the others did this as it would prevent this disconnection that I agree is there.

  • whig66

    Doctor as a Healthcare IT person I think that everyone, including you, needs to be included in any beginning process and have that involvement occur until the system is superseded. There is so much in the way of upper-level IS and cliques socking it to the doctors and staff who use them all the way down to the little guy who gets the call at the help desk. Don’t some hospitals do it better? I like EMR and CPOE; it’s just that firms don’t always have the touch when writing the software and facilities screw up the purchase, implementation, and support. We underlings can only call the people assigned to the apps and listen as we try and present ourselves as sympathetic and knowledgeable when a doctor speaks unto us- and sometimes not gently.

  • whig66

    It’s lack of teamwork and lack of training. Train the healthcare workers a little better. The lag times come from something that starts when people acquire the systems and supporting infrastructure. The white and grey suits need to sit together and not say, “This is what we bought; go support it”. EVERYONE in IS and clinical communities- as well as financial and insurance- must get together before signing the check for this stuff.

  • $11404556

    That pesky line under the masthead declaring this the finest site for satirical medical news just seems to go over most people’s heads.

  • Oh Gomer

    I guess one of the funniest parts of this website is the fact that so, so, so many people seem to think it’s serious. I’m hoping many people reading this are not actually healthcare or hospital workers, because their ignorance would make more sense, but come on people……..

  • Oh Gomer

    I baffles me that people seriously even think this website is anything but satire. This is “The Onion” of medical news.

  • Guest

    as much as I hate taking a pen to paper b/o my awful handwriting (I can’t read my own notes sometimes) I am disgusted with the lack of quality in all of the EMRs I have had to use so far (McKesson, Cerner, Epic). If my home computer functioned at the pathetic level these EMRs do I would have taken it back for a full refund long long ago. I do everything on the computer at home and it all works fine because I invest in the best product! I think the problem is that hospitals do not want to invest money in obtaining and maintaining quality EMRs

  • Austin

    I hope this is article is satirical because if not it is unfortunately the most ignorant health care article I’ve read for years. Based on the feedback and timing of the responses from physicians, etc. this is in reference to the physicians not taking training, etc. and the outpatient staff not preparing their documents for easy upload. This article has no facts as proof (ie the fact that all paper-to-digital system conversions have over a 60% physician acceptance ratio) and wreaks of poor journalism. Just another typical uneducated writer blogging for 59k+ hits on his/her site. Other useful thoughts forgotten: research based on medical statistics data saves lives. It is accepted as common knowledge that sepsis predictability systems have saved thousands of lives so far this year alone (collecting certain vital conditions and alerting physicians and nursing staff to change ). Do you also realize these healthcare IT companies hire physicians to design the front-end of the systems for them? Did you think of the fact that there are standards for document preparation that take seconds for outpatient clinics to help prepare documents for inpatient scanning? Do you also realize no IT geek ever talks directly to a physician where physicians are trained by associates who are hired as front-end/physician’s assistants, not IT geeks? Do you think accessing a single-copied EHR from one facility and not having that record for an ER from another inpatient facility would be as ‘advanced’ as having that record accessible from both sites simultaneously (via scanned record)? Please do your due diligence and research instead of spreading ignorance to the masses. Healthcare IT has already changed the future of our children’s health and will continue to do so if we just keep funding the moderate amount of research money to advance IT analysis of clinical data.

  • Lori Kitchens

    I have used both. I like paper charting. I am one of those nurses that doesn’t feel comfortable with just clicking boxes for an assessment. I like written out, head to toe assessments. I always add a nurses note. I do find with you do that it makes it a little easier. Medication Reconciliation is a pain in the rear with EMR. On paper…… Highlight. EASY! I haven’t found a good EMR yet. Sometime Dr orders are hard to read but slow down take your time and ask a friend. LOL you can do this!

  • Josh

    The reason med errors went unseen is due to them all being on paper. You can’t track that. It is easy to hide behind paper and then the blame game can go on forever.

    To me you are all correct. Communication is the issue, but it is from both sides. Physicians unhappy about moving to the EHR so they don’t provide worthy feedback until it is too late. Programmers that think they know what they are doing and that a certain decision is theirs to make rather than bringing it to their clinical governance committees. I have been on both sides. You won’t have a successful EHR until you have a good working relationship with each other.

  • Jeff

    That is the problem. IT does not seek input during programming. It only seeks feedback after implementation- thus frustrating all parties. I have never seen as many mistakes and medication errors in 25+ years with paper documentation as I have seen in the 4 months since an EMR system was “forced” on me.

  • Wen Dombrowski MD

    But plenty of healthcare orgs lose/misplace chart binders or the worn-out pages fall out. Or spill coffee onto it.

  • Randy Tobler

    EMR is a fertile field for misinformation (prepopulation and maddening time clicking and/or editing Dragon), mistakes are up tremendously (incessant overrides on inane and lightning-strike odds med warnings, less face time with patients, click/navigate/data entry fatigue hurry errors). Most importantly, in 25 years I’ve never seen (and sad to admit personally experience daily) such severe and deep erosion of morale. We now find patient care a huge P.I.A. because job #1 is the EMR, jumping through the meaningful use hoops, avoiding compliance traps, avoiding RAC audits etc. No one talks about patients, our an interesting case at meetings anymore. Thanks to all the bureaucrats and some in our own profession who sold us down the river. Enjoy your huge personal benefits in ruining medical practice. The mistakes, indifference and loss of some good clinical experience through early retirement is on your hands.

  • Woman_in_CA

    “Apparently, much like hospital administration, IT in the healthcare sector doesn’t attract the best and brightest. What a shock.” Bitter much? And health care providers are the best and brightest? I’ve been in the health care industry for 20+ years. Over that time, I’ve seen some pretty piss poor work from health care providers, including negligently causing a patient’s death. That was during the paper charting era. Oh my, who to blame now?

  • DrJKH

    How efficient is illegible handwriting from people who are bad enough at printing, but insist on scribbling in archaic cursive? How crash proof are charts that are constantly disappearing, being “borrowed for a second (hours),” or being hogged by some nurse who is oblivious to the fact that she’s not the only one who uses it?

  • DrJKH

    Learn the difference between “namecalling” and labeling things what they are. With YOUR attitude, you SHOULD be on your way… to the unemployment line.

  • DrJKH

    Epic, although not the most popular, is pretty good. It has a VERY steep learning curve, as most take about 6 months to become proficient enough with it. It does have its drawbacks. You have to look in several places to get one piece of info. You have to click A LOT of things to do a simple task. Still, it’s better than most because of the customizable templates and smart fields. Still, a lot the problems with it are because of government mandated nonsense such as meaningless use, which is not the company’s fault.

  • James O’Brien, M.D.

    electronic records on a hard drive=good
    electronic records on the cloud=Orwellian
    paper records for psychiatric conditions and STDs=better

  • Morgan

    The largest EHR in the US – Epic was designed by Judy F to help her doctor husband actually and one reason some docs (with little training) find it confusing is because they let almost every health care system customize it

  • Johnautobahn

    Cerner is the bee’s knees compared to Epic. Who the heck designed this POS the redundant department of redundancy?

  • Johnautobahn

    Bingo. You’re a moron who deflects responsibility for your piss poor work. Apparently, much like hospital administration, IT in the healthcare sector doesn’t attract the best and brightest. What a shock.

    So please be on your way and stay on your way. Feel free to rejoin the rest of us when you can design an EHR system that doesn’t involve redoing a med rec list every time you put in an order after transferring a pateint (Hello the patient is still on the floor. I’m still responsible for keeping the overly concerned nurse happy about repleting the patient’s Mag of 1.7).

  • Joseph Schmoe

    I can look at orders in chronological order in Epic, only in Epic, I can actually read them.

  • Joseph Schmoe

    Oh please. Get an EMR that’s from the late 20th Century. Paper is ridiculous, and just because this guy can’t figure out the EMR doesn’t mean paper is better. Sorry, it just isn’t. In the EMR I use I can access anything I need in seconds. On paper it took ages, and often you couldn’t find it.

  • Philcolby

    As someone who has worked in IT and it also a physician, the problem is that as massive commercial EMR products are rolled out, when feedback is offered, it largely falls upon deaf ears. This is because customization costs money and many hospital systems fail to adequately invest in this. From a human factors perspective, most commercial EMR systems are grossly inadequate when they really should not be. I would suggest that there are plenty of healthcare workers who are willing to collaborate, but are easily discouraged when their suggestions or design critiques are noted and dismissed. Efficiency requires investment and there does not seem to be money in going that next step. Why improve the product when you can simply force alteration of user behavior?

  • Jeff Margel

    As an IT Director and developer of a police information system I can see both sides of the issue. The system I developed is being used by only 5 departments right now and I can already see how each department is unique in how they not only want to enter information but to retrieve it. These large ‘EHR’ corporations push out a product and basically don’t have a choice when they say ‘You don’t have a choice in how this program is developed’ only because it would literally be impossible to customize their software to each hospital.
    What we did was any customizations that a PD wanted, we made it an ‘option’ for the other PDs to use. They are not forced to use the system in a specific way. As developers of such a product they also need to have training in the field they are developing for as well. A lot of companies will promise the moon and deliver a product that was much too hyped up. Once they get the money they don’t have much incentive to change a system (unless it’s a huge bug/error). I’ve seen that as a IT Director as well.
    When we developed our police system we had numerous contacts that would review our system as we developed it. Our first customer was back in 2004 and since then many changes have been made only because of the way information and other technologies change. My recommendation is that if a hospital or any organization wants a records management system they must work with the developer on a daily basis. The hospital needs to hire some doctors, nurses and clerical staff to ONLY sit and work with the developer of the product. It’s a huge investment but well worth it in the long run.

  • Betsy Toups Harrel

    AMEN, SISTER! That’s what we have, lol!

  • TruePatriotism

    It’s funny because it’s true.

  • EvilTechnocrat

    Right on Dr. JKH. Now let’s hop on our high horses and race a steam locomotive. I’m sure we can win! :-)

  • Jody Reinelt

    I don’t mind the EMR. What I do have concerns about are the internet down time, the decreasing speed of the processing process and the time it takes to multi click to get to the area I need. Come on- 2 log in’s just to get to the patient list and 4 more clicks just to get to my charting. That is if I don’t lose connection and the battery on the computer does not die. The computers are so decreasing patient care time and increasing charting time. That is why I despise EMR. Let Obama be my patient and see how long it takes me to get him a pain pill just because the computer is holding me up and I can’t verify it fast enough for him!

  • Psychiatrist

    Oh dear God, Cerner, the very word gives me chills. That company should be prosecuted!

  • Steph W

    It’s not all or nothing- there are definitely good and bad EMR systems. I absolutely LOVE Medhost, the system we use in my ER. But I have also used Cerner and Epic, and I would pick paper charting any day over either of those.

  • Jacob Nyhart

    I agree CP. I have been involved with 3 major healthcare/EMR implementations which included everything from the initial product evaluations to the final implementations – and in every single one of those cases, the technology people were much more involved than those who would ultimately be using it – leaving the technology folks to try to guess if the products fit in with their expectations and work flow processes. More often than not, the health care workers just expected to start using the new product with their old work flow practices – and that is simply not reality. When the input of the users is vital to the development of the processes and applications, they need to be more involved. It is very frustrating. In fairness, there are some healthcare workers out there who do recognize the importance of their involvement – and there are also some very poorly built EMRs, so I won’t place the blame on any single entity – but as a technology professional who works specifically in the healthcare field, and having firsthand knowledge of the processes, I can definitely say there is too much of a disconnect between the developers and the users.

  • Donna Bogner

    Like a lot of things in medicine, sometimes the best always comes back around. Technology is good but not the end all to solve problems.

  • Carol Tesson

    Listen to DrJKH…you clearly don’t know what you are talking about. And from your overly verbose explanations and your willingness to be “open for discussion on how we can better serve the industry” it is more than clear that you have never been involved in hands on health care. I have been an RN in an ER for 38 years and have seen more med errors and missed and duplicated orders in the past two than I ever saw in my entire career and it is all the result of EMR’s. Don’t waste your time trying to patronize, no one in our field believes any of you anymore. We only wish we could go back.

  • CP

    I’m not the one namecalling and blindly dismissing very pertinent issues.

    This attitude between departments is what’s killing productivity in our fields. As the IT Director for a nationwide healthcare provider offering customized EMR systems, I’m open for discussion on how we can better serve our clients. If you’re not willing to contribute anything meaningful to the discourse, then I’ll be on my way.

  • Celeste Montanaro

    I’ve never had a chart “Crash”. Electronic records are not safe or efficient.

  • Espie Salazar

    Kimberly Beard Susan L. Taylor interesting article.

  • DrJKH

    IF you could actually read them. Odds are highly against that though.

  • DrJKH

    Save the pompous pedantic lectures. You obviously don’t know what you’re talking about.

  • Angela Bahret

    Are they going to inservice everyone how to use them? Lol

  • Daniel Boll

    Less expensive to fix when thrown

  • CP

    Healthcare workers hold the same amount of responsibility in the creation of good EMR systems as the programmers themselves. The workers’ ability – or inability, in most cases – to clearly communicate their needs to software engineers and developers (who are not IT, btw) is the reason why so many EMR systems are a mess. It’s not a programmer’s responsibility to know about healthcare procedures, just as it’s not an RN’s responsibility to know Java syntax. Healthcare workers must be willing to provide support and input throughout the design process for a successful system to be developed. It doesn’t help the industry when workers play the blame game when little or no effort is given for collaboration. Anything is possible with technology, but nothing will happen if needs are not communicated.

  • Greg Simpson

    Didnt we have paper charts in the 1950 s

  • Barb Sibila

    So true!!! I am a CDIS RN Trying to review a chart now is sooooo hard. I hate copy and paste.

  • DrJKH

    EMR has it’s problems, mostly because it’s designed and run by IT geeks who know nothing about healthcare. But it still beats trying to decipher illegible handwriting, writing out notes, redundantly hand copying lab values and vitals, and dictating. All of that stuff is for third world medicine.

  • John Zelko

    At least on paper you could follow the previous shift guys thoughts by looking at the orders in sequence. Thought , action, results. Perfect.

  • Gomerblog

    That was a guest author for Howard, first crack..more to come from him!

  • Deborah Renfro Vance

    The more computer charting we do, the more paper we generate

  • Khalid Manzoor

    “From too much zeal for the new and contempt for what is old, Good Lord, deliver us.” – Sir Robert Hutchison

  • Bobbie Schindler

    That looks like all our charts that still exist with electronic charting.

  • Denise Gordon

    Not sure if this is a joke or true

  • Kyle Compton

    The meditech system is only slightly more advanced than trying to chisel a note on a stone tablet.

  • Donna Hall

    at least with paper you could actually figure out what was wrong with pt- this looking at check marked boxes is BS

  • Liz Carlson

    We have Epic Nikki Chrobak. But I don’t think its the same Epic (as weird as that sounds). We also use paper charts along with it ;)

  • Susan Dykhuizen

    This IS hysterical. Truth be told I love the fact I can read doctor’s notes and zip around an EHR with lightening speed.

  • Robert Rau

    Works in a blackout …..

  • Robert Rau

    Works in a blackout …..

  • Thomas Devore

    Our “chairside” system is getting upgraded to go faster Saturday. Gonna be a long day in dialysis…..

  • Deb Steiber

    Absolutely love this idea!

  • Victoria Davis

    In my dreams. Oh, that’s right, I don’t really care because I’m retiring from all this anyway!

  • Betina Cline

    Meanwhile, we just chart/click/write orders & patient info in 20 different places. Cause its safer & more efficient. (Sarcasm)

  • Caskey Weston

    But can you read it? Or find it when you need it!

  • Amber Parkin

    I wish!

  • Tassey Stuscavage

    This is what our hospital currently uses anyway…..

  • Michael Steele

    Yea! Paper!

  • Deborah Colony

    Pardon me while I roll on the floor laughing…..using meditech, it takes 2x as long to make a chart.

  • Darlene Winch

    It seems so simple! Like I don’t know why we didn’t think of this sooner!

  • Michelle Nurse

    Lol

  • Aimee Green Hancock

    Awww, the good ol’ days!!!

  • Erin Beth Grote

    Janet Shepherd

  • Malaya Rivard-Streeter McCraw

    I wish!

  • Lena Malamut

    Nothing like a paper trail

  • Lucy Rosamond Jones Silk

    I wish.

  • Jennifer Simoneau

    It’s the circle of life.

  • Angela Bono Reed

    Hilarious!

  • Darlene Howland Yager

    STOP!!!!

  • Jenn

    You do realize this article is satire??

  • Mike Pudlinski

    We still have the binders. When you ask the clerk for a Pmh and med list, they say “here ya go!” And hand you an empty binder. It’s a great system

  • William Tessier Sr.

    Omg this could be the answer to the annoying problem of why dose someone in another country have my med charts and please repeat that in a slow dialect I’m having and interpreter explain it to the pharmacy at walmart

  • Veronica Khauv

    Saatchi Patell

  • Jennifer Delzell

    Those were the days!

  • Therese Monse

    Love this!

  • Julie Reichard

    Haha:)

  • Marcus Wayne Trejo

    Good old days, my friends.

  • Marcus Wayne Trejo

    Good old days, my friends.

  • Busola-Grace Oluwajoba

    Lol

  • Busola-Grace Oluwajoba

    Lol

  • bojimbo26

    My God , someones using common sense ( dirty word in the UK ) .

  • Mark de Cruz

    BahahahA. Has the words Fiona Stankey hospital all over it

  • Michael Long

    The one about Howard is even better.

  • Randal Dunlap

    Those were the daze !

  • Phil Petty

    Sharing

  • Lisa Cantrell

    LOL

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