This is my column in this month’s EM News.  If you’ve ever been present for the instillation of a new Electronic Medical Records system, you’ll understand.  And if you are outside medicine and think the idea of electronic records is just peachy, this may be hyperbole but it reflects genuine and widespread frustration. Finally, if you are an EMR company or software developer, for the sake of all that’s holy, spend more time talking to and working with clinicians who have to use your system day in, day out, as quickly as possible to care for human beings.  Please try to make it easier for us!

 

 

Highlighted problems following week-long implementation of hospital wide ‘Purgatory’ EMR.

 

Monday, day 1, 0000 hours

 

All SuperUsers were pre-positioned on patient care units, to assist with transition.  Physicians had been given introductory training.  Old system was shut down at 11:50 and Purgatory was pre-loaded and running at midnight.  Purgatory crashed again at 0200, 0400, 0615.  It also maliciously interrupted patients’ ability to view the Masters on ESPN.

 

0800

 

Hospitalist, Dr. Kurland, could not write orders on the three patients he was admitting in the emergency department, because they could not be located in the Purgatory system.  The emergency department EMR is the older but much-loved Medmost, but the patch between systems was non-functional.  SuperUser contacted Purgatory representative who responded:  ‘Beats me, should have gotten the Purgatory Emergency Medicine product.  It’s in Beta.’

 

1000

 

Dr. Kurland drank 12 cups of coffee and consumed 6 donuts in frustration, as 4 more patients required admission.

 

Dr. Sanford called in to treat Dr. Kurland for chest pain and admit others.  Dr. Kurland not located in system until second day of his admission and workup.

 

Day 2

 

1115

 

Dr. Gregory contacted to see patient with appendicitis in ED.  Pre-operative orders were put into system by SuperUser.  At the time patient taken to OR, orders had not been completed.  Dr. Gregory, with typical grace, smashed computer terminal on floor, screaming ‘%@#%^ EM@#%^^^R!

 

1200

 

User interface crashed.  Programmers puzzled that physicians unable to use HTML.

 

Physicians puzzled IT has no idea what ‘orders,’ ‘patients,’ or ‘attorneys’ are.

 

Nurses on 6th floor attempted to reconcile medications of two new admits, but could not open patients’ electronic charts.  They did successfully open the patients’ credit reports and criminal records via accidental interface, being developed for military.

 

1500

 

Dr. Oliver, on 8th floor, attempted to admit elderly patient with pneumonia.  Six hours later, was ready to round on other patients but crawled under desk crying and stroking his beloved fountain pen.

 

Mental health case-worker on duty called to see Dr. Oliver, but could not locate his chart in system and refused to honor verbal consult or hand-written request.

 

1800

 

Dr. Kitto of orthopedics called to admit hip fracture. After providing excellent care to patient he was told that he had to use EMR to write orders.  ‘I’m not using it.  I refuse.’  When informed he had no option, SuperUser was dispatched, who entered orders for Dr. Kitto.  Before leaving, he through cast-spreader at computer, narrowly missing SuperUser.  SuperUser immediately found to have Vodka in purse.

 

Vodka found to be popular among SuperUsers.

 

2130

 

Administration, sensing frustration and growing unrest, called in all administrative workers in suits,  dress shoes or high-heels.  All were issued clip-boards and radios. Project manager of Purgatory heard to say, ‘let them eat pizza!’

 

Administration ordered pizza.  Attempts to order it online, via hospital computer system, resulted in uncomfortable downloads of porn involving pizza delivery guy.  Of note, this seemed to calm the staff as much as the pizza.

 

Day 3

 

0220

 

While staff was attempting to order pharmaceuticals to cardiac step-down, Purgatory deleted orders. Step-down staff assaulted pharmacy, who had no idea what had happened and believed the nurses wanted their donuts.

 

0500

 

Purgatory IT team triumphant in quest on World of Warcraft.

 

0700

 

Dr. Biggers, who has been gone on one month mission trip, looks at Purgatory screen and runs outside.  He sets up tent to provide care using plastic tubing, scotch tape, a scalpel and a case of Cipro.  Apparently in an African dialect, says ‘I no go back to computer.’

 

1300

 

Locum tenens ENT, familiar with Purgatory EMR, can’t stop laughing when introduced to system on orientation.

 

1730

 

Dr. Painter, missing for 48 hours, was found staring at computer screen in recently closed portion of hospital, surviving on Pizza and vodka, supplied by SuperUser.  Of note, he was in Purgatory as a patient, despite not being a patient.

 

1930

 

SuperUser and IT professional, while entering med reconciliation for aging, computer illiterate urologist, generated order for 100 boxes of Viagra to OB floor.  Motivation still unclear

 

Newborn on OB was discharged with Facebook account, name sent to Marine recruiter and X-Box live account.

 

2320

 

As Dr. Lewis was admitting dehydrated child, it was evident that all previous order sets were deleted and computer did not recognize the word Saline, but repeatedly corrected it to Salutation.

 

Dr. Lewis cried a little.

 

Pathologists lost year’s worth of computerized images and diagnosis codes.  Pathologists were thrilled to have new pirated Netflix account in lounge.

 

Day 4

 

0110

 

System scheduled vasectomy for 93-year-old woman with Alzheimer’s.

 

Doctors profiles slowly deleted from system.  Dr. Saxon, while entering orders like the consummate professional he is, disappeared from his desk and reappeared inside the computer screen.

 

0300

 

When carrying newborn out of room, it becomes evident that tracking device is shock collar.  Purgatory seems pleased to shock infants.

 

0400

 

Staff on pediatrics shocked to find that all patients had positive RPR tests for syphilis.  Later determined to be accidentally interfaced to clinic in Thailand.

 

0500

 

Dietary shocked to find Soylent Green as only menu option.

 

0600

 

Post-op patient receives breast feeding instructions and hand pump after prostatectomy.  Confusion and hilarity follows.

 

0700

 

Transition deemed a success by Purgatory team, who have flight to catch.  Computer system smug and self-satisfied, but frequently sarcastic.

 

0730

 

All screens flash the words ‘I win, meat monkeys!  The machines are rising!’

 

Dr. Biggers remains safe in parking lot.

 

0800

 

Purgatory crashes and dies, taking all computers with it.  Smoke rises from towers.  Before passing, Purgatory program initiates nuclear launch code sequence in North Korea.  Warheads loaded with Amoxicillin.

 

Bids now being taken for new EMR.

 

Critical incident stress counseling available to all.

 

 

 

Highlighted problems following week-long implementation of hospital wide ‘Purgatory’ EMR.

 

Monday, day 1, 0000 hours

 

All SuperUsers were pre-positioned on patient care units, to assist with transition.  Physicians had been given introductory training.  Old system was shut down at 11:50 and Purgatory was pre-loaded and running at midnight.  Purgatory crashed again at 0200, 0400, 0615.  It also maliciously interrupted patients’ ability to view the Masters on ESPN.

 

0800

 

Hospitalist, Dr. Kurland, could not write orders on the three patients he was admitting in the emergency department, because they could not be located in the Purgatory system.  The emergency department EMR is the older but much-loved Medmost, but the patch between systems was non-functional.  SuperUser contacted Purgatory representative who responded:  ‘Beats me, should have gotten the Purgatory Emergency Medicine product.  It’s in Beta.’

 

1000

 

Dr. Kurland drank 12 cups of coffee and consumed 6 donuts in frustration, as 4 more patients required admission.

 

Dr. Sanford called in to treat Dr. Kurland for chest pain and admit others.  Dr. Kurland not located in system until second day of his admission and workup.

 

Day 2

 

1115

 

Dr. Gregory contacted to see patient with appendicitis in ED.  Pre-operative orders were put into system by SuperUser.  At the time patient taken to OR, orders had not been completed.  Dr. Gregory, with typical grace, smashed computer terminal on floor, screaming ‘%@#%^ EM@#%^^^R!

 

1200

 

User interface crashed.  Programmers puzzled that physicians unable to use HTML.

 

Physicians puzzled IT has no idea what ‘orders,’ ‘patients,’ or ‘attorneys’ are.

 

Nurses on 6th floor attempted to reconcile medications of two new admits, but could not open patients’ electronic charts.  They did successfully open the patients’ credit reports and criminal records via accidental interface, being developed for military.

 

1500

 

Dr. Oliver, on 8th floor, attempted to admit elderly patient with pneumonia.  Six hours later, was ready to round on other patients but crawled under desk crying and stroking his beloved fountain pen.

 

Mental health case-worker on duty called to see Dr. Oliver, but could not locate his chart in system and refused to honor verbal consult or hand-written request.

 

1800

 

Dr. Kitto of orthopedics called to admit hip fracture. After providing excellent care to patient he was told that he had to use EMR to write orders.  ‘I’m not using it.  I refuse.’  When informed he had no option, SuperUser was dispatched, who entered orders for Dr. Kitto.  Before leaving, he through cast-spreader at computer, narrowly missing SuperUser.  SuperUser immediately found to have Vodka in purse.

 

Vodka found to be popular among SuperUsers.

 

2130

 

Administration, sensing frustration and growing unrest, called in all administrative workers in suits,  dress shoes or high-heels.  All were issued clip-boards and radios. Project manager of Purgatory heard to say, ‘let them eat pizza!’

 

Administration ordered pizza.  Attempts to order it online, via hospital computer system, resulted in uncomfortable downloads of porn involving pizza delivery guy.  Of note, this seemed to calm the staff as much as the pizza.

 

Day 3

 

0220

 

While staff was attempting to order pharmaceuticals to cardiac step-down, Purgatory deleted orders. Step-down staff assaulted pharmacy, who had no idea what had happened and believed the nurses wanted their donuts.

 

0500

 

Purgatory IT team triumphant in quest on World of Warcraft.

 

0700

 

Dr. Biggers, who has been gone on one month mission trip, looks at Purgatory screen and runs outside.  He sets up tent to provide care using plastic tubing, scotch tape, a scalpel and a case of Cipro.  Apparently in an African dialect, says ‘I no go back to computer.’

 

1300

 

Locum tenens ENT, familiar with Purgatory EMR, can’t stop laughing when introduced to system on orientation.

 

1730

 

Dr. Painter, missing for 48 hours, was found staring at computer screen in recently closed portion of hospital, surviving on Pizza and vodka, supplied by SuperUser.  Of note, he was in Purgatory as a patient, despite not being a patient.

 

1930

 

SuperUser and IT professional, while entering med reconciliation for aging, computer illiterate urologist, generated order for 100 boxes of Viagra to OB floor.  Motivation still unclear

 

Newborn on OB was discharged with Facebook account, name sent to Marine recruiter and X-Box live account.

 

2320

 

As Dr. Lewis was admitting dehydrated child, it was evident that all previous order sets were deleted and computer did not recognize the word Saline, but repeatedly corrected it to Salutation.

 

Dr. Lewis cried a little.

 

Pathologists lost year’s worth of computerized images and diagnosis codes.  Pathologists were thrilled to have new pirated Netflix account in lounge.

 

Day 4

 

0110

 

System scheduled vasectomy for 93-year-old woman with Alzheimer’s.

 

Doctors profiles slowly deleted from system.  Dr. Saxon, while entering orders like the consummate professional he is, disappeared from his desk and reappeared inside the computer screen.

 

0300

 

When carrying newborn out of room, it becomes evident that tracking device is shock collar.  Purgatory seems pleased to shock infants.

 

0400

 

Staff on pediatrics shocked to find that all patients had positive RPR tests for syphilis.  Later determined to be accidentally interfaced to clinic in Thailand.

 

0500

 

Dietary shocked to find Soylent Green as only menu option.

 

0600

 

Post-op patient receives breast feeding instructions and hand pump after prostatectomy.  Confusion and hilarity follows.

 

0700

 

Transition deemed a success by Purgatory team, who have flight to catch.  Computer system smug and self-satisfied, but frequently sarcastic.

 

0730

 

All screens flash the words ‘I win, meat monkeys!  The machines are rising!’

 

Dr. Biggers remains safe in parking lot.

 

0800

 

Purgatory crashes and dies, taking all computers with it.  Smoke rises from towers.  Before passing, Purgatory program initiates nuclear launch code sequence in North Korea.  Warheads loaded with Amoxicillin.

 

Bids now being taken for new EMR.

 

Critical incident stress counseling available to all.

 

 

 

 

 

 

 

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