{"id":1147,"date":"2010-11-07T12:16:11","date_gmt":"2010-11-07T17:16:11","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=1147"},"modified":"2015-06-04T15:24:27","modified_gmt":"2015-06-04T19:24:27","slug":"welcome-to-the-click-fest","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/welcome-to-the-click-fest\/2010\/11\/07\/","title":{"rendered":"Welcome to the Click-Fest"},"content":{"rendered":"

\"mouseLet me start by confessing I’m something of a gadget freak.\u00a0 I was an early Palm Pilot adoptor, loved the iPod from the get-go, and need to avoid CNET, Engadget, Gizmodo, and David Pogue’s columns for the New York Times <\/em>when deadlines loom.<\/p>\n

Not surprisingly, I embraced the shift to electronic medical records (EMRs) enthusiastically. While I acknowledge that sometimes EMRs slow clinicians down a bit, and have terrible — horrible<\/em> — interoperability (how’s that for a tech writer term?), I believe the net benefits\u00a0from EMRs outweigh the problems. \u00a0And our EMR has many time-saving and just plain nifty features.<\/p>\n

However …<\/p>\n

Every so often something happens with an EMR that is so shockingly inconvenient that it makes me wonder whether we’re on a road to EMR purgatory.<\/p>\n

Example:\u00a0 prescription refills.<\/p>\n

This is how we used to OK a prescription refill\u00a0in our practice:<\/p>\n

E-mail from RN or LPN:\u00a0 “Hi Paul, ok to refill Joe Smith’s Bextrim 10 mg?”
\nResponse:\u00a0 “Yep, one a day, 11 refills.\u00a0 Thanks.”
\n[RN or LPN then refills via our EMR by clicking “renew” and sending electronically to pharmacy.]<\/p><\/blockquote>\n

Simple. \u00a0Time required for MD? \u00a0Around 3 seconds. \u00a0Plus, easy to manage on a hand-held device — you don’t need a computer.<\/p>\n

So here’s how we’re supposed to do it now (physician clicks or keystrokes in brackets):<\/p>\n

    \n
  1. RN or LPN enters request for refill into queue.<\/li>\n
  2. Email is automatically generated that gets sent to MD stating that he\/she has a refill request. \u00a0E-mail does not include patient name, medical record number, medication, or pharmacy info. \u00a0It’s just a notification. \u00a0In other words, it’s completely useless on a hand-held device — except as a form of taunting. “You have a task, but you can’t do it until you log into a computer, log into the EMR, and follow multiple steps — nah-nah, nah-nah.”<\/li>\n
  3. At computer, MD clicks on email, then deletes it [clicks 1 and 2].<\/strong><\/li>\n
  4. MD switches to EMR [click 3].<\/strong><\/li>\n
  5. MD clicks on refill request [click 4].<\/strong><\/li>\n
  6. Refill screen appears. \u00a0Screen looks like it was developed by a web designer who collects mouse clicks the way that some people collect pennies or odd bits of string — the more the better! \u00a0It literally has four separate panels, each panel containing various radio buttons, check boxes, drop-down menus, scrolling lists, comment fields — a veritable panoply of web interactive tools.<\/li>\n
  7. In second panel, MD clicks on “Renew” [click 5].<\/strong><\/li>\n
  8. At bottom of page, MD clicks on “Mark as complete” [click 6].<\/strong><\/li>\n
  9. At bottom of page, MD clicks on “OK” [click 7]<\/strong>. \u00a0Yes, there are two separate <\/em>clicks for “Mark as complete” and “OK.”<\/li>\n
  10. “Sign” is now highlighted red in the menu. \u00a0MD clicks on “Sign” [click 8]<\/strong>.<\/li>\n
  11. Sign page appears, with request to enter key. \u00a0MD enters key [5 keystrokes]<\/strong> and clicks “OK” [click 9]<\/strong>.<\/li>\n
  12. Prescription page appears. \u00a0MD clicks “Send” [click 10]<\/strong>.<\/li>\n
  13. Prescription is sent to pharmacy electronically.<\/li>\n<\/ol>\n

    Mind you, this is for one patient, and one medication. \u00a0More meds and\/or patients? \u00a0More clicks.<\/p>\n

    I understand that there are medicolegal reasons for documenting that MDs review and approve renewals. \u00a0But there has to be a better way — and of course, there are many, two of them implemented in the commonly-used electronic medical records EPIC and the terrific one at the V.A.<\/p>\n

    But until electronic medical record designers start reviewing “best-of” strategies from their competitors, I’m afraid there will be lots of these one-step-forward, two-steps-back experiences for us clinicians, just like this one.<\/p>\n","protected":false},"excerpt":{"rendered":"

    Let me start by confessing I’m something of a gadget freak.\u00a0 I was an early Palm Pilot adoptor, loved the iPod from the get-go, and need to avoid CNET, Engadget, Gizmodo, and David Pogue’s columns for the New York Times when deadlines loom. Not surprisingly, I embraced the shift to electronic medical records (EMRs) enthusiastically. […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,7,8],"tags":[],"class_list":["post-1147","post","type-post","status-publish","format-standard","hentry","category-health-care","category-misc","category-patient-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1147","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=1147"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/1147\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=1147"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=1147"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=1147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}