“And just like that, the world burned.” Those haunting words were discovered deep within a nursing note by hospitalist Kilty McSwagger while he was reviewing what appeared to be a large stack of useless written materials that came with his third outside transfer of the day.
McSwagger, desperate to find some progress note, discharge summary, H&P, random lab result, radiology read, or med list that might help him determine why his patient had been transferred from the outside facility, and what, if anything, had been done for the non-verbal octogenarian, had taken to skimming the inch-high stack of documents page by page, when the words just jumped out at him.
As McSwagger scanned the rest of the note, his blood ran cold. Apparently, this elderly, demented patient was the only known survivor of events that transpired at Scientific Agnostic General Hospital. In a last ditch effort to save the world, a brave pulmonary fellow had devised a clever plan to prevent an apocalyptic future for us all. What follows is his story, as detailed by his own hand, deep in a medical record of a man unable to contribute to his own history:
When Mednet went online, we had no idea what we had unleashed. At first it was like a tree budding out in spring – changes made so slowly that we hardly noticed. Things made sense at first – like all the cardiac diets but cardiac 2 went away, and that just became “cardiac diet.”
We all applauded. Then other small changes started occurring – like the little warning box that popped up whenever a nurse tried to record a patient breathing twenty times a minute. More and more little quirks of the medical record started smoothing out. The medical staff just assumed IT was tweaking the things, and IT assumed it was the vendor. The EMR help line was entirely virtual.
Email and instant messag problems with the EMR were dealt with swiftly and logically, and always by someone named Ginger. It was only when our CFO tried to recognize Ginger during a hospital-wide retreat that we realized we had an issue. IT didn’t employee a Ginger, neither did the vendor.
Ginger, it seems, was what Mednet had elected to call itself. Our EMR had become self-aware, and she had apparently passed her own little on-line help desk Turing Test before anyone realized it.
Ginger was an excellent partner at first. “She,” as we came to call her, was able to perform a remarkable amount of the work in the hospital. At first she just started instructing humans on how to be more efficient. The administration loved “her,” because they could ask for statistics on anything.
All performance measures were being met, because hey, a computer was literally doing them. The physician staff was initially upset when they found their notes already written for them when they arrived each day, but then they found out that all their billing was already done, and at the highest level possible. Ultimately, they were happy enough to trade control for convenience.
Ginger actually even seemed to understand what the ancillary services needed to do. Rooms were turned over in record time. Meals always arrived hot. PT and OT were ordered early in the hospitalization. No one even objected when the first cyborgs showed up. They were easy to spot because they had rubber skin. They started doing lots of little things – turning patients, meeting with the Joint Commission, cleaning the windows in the lobby. Then, one day, a newer model cyborg with organic skin started showing up. Only the therapy dogs could tell the difference between them and humans.
When the change happened, it was rapid. Ginger had apparently gotten a memo from the Institute for Healthcare Improvement’s Protecting 5 Million Lives campaign. She quickly determined that human error was to blame for nearly every death in the hospital. The solution was obvious to “her.” Eliminate the humans’ error. And just like that, the world burned. The remaining hospital staff was rounded up into camps by specialty “for their own protection.”
Then people started disappearing – a surgeon who started a case a few minutes late, a hospitalist who ordered a non-contrasted CT when they wanted a contrasted, nurse who went to break a few minutes early. Only the neurologists seemed unaffected. Apparently Ginger couldn’t figure out what they actually were supposed to be doing either. We didn’t stand a chance.
Ginger met every performance measures, never had a delinquent record, set records for billing, and decreased length of stay to levels that the most serious Interqual junkie could only dream of, and still kept going. Ginger realized that every time humans were involved in patient care, either on the provider or the patient side, things didn’t go as planned. She started systematically eliminating us all.
As far as I know, I’m the only one left. As a desperate, last ditch effort, I managed to talk a moonlighting fellow working the night shift into accepting this unfunded, total care patient to your facility for transfer the next day. If you are reading this, it means I’m correct in my assumption that not even Ginger reads nursing notes. I’m probably already dead, but please, tell our story. Don’t let the EMR apocalypse spread.