My fourteen year old son had a sports physical yesterday. At the end of the visit we were handed a sheaf of papers summarizing everything that had occurred. We headed toward the lab for a blood draw, then drove home. Finally, two hours after the appointment was over, I sat down to review the paperwork I’d received. There it was:
There are a few problems with this. First, obviously, is that the information is wrong. My son did not have his first menstrual period at age 13.
Second, poor programming permitted this error to occur. When the patient is a male, it should not be possible to enter data in a “females only” section of the chart. Either the entire section should be greyed-out, or selecting “male” in the gender field should generate an “N/A” entry in all female-only fields. Worse, even for female patients, it should not be possible to enter any data in the second and third fields when the first question received a “no.” This is incredibly sloppy programming. If this is an example of the quality of work that’s gone into writing EHR software, it’s no wonder that it took an act of Congress to coerce physicians into purchasing this garbage.
After laughing at the typo, I checked the rest of the paperwork to make sure there weren’t any other surprises, then phoned our doctor’s office to request that they make the appropriate correction. The receptionist was very nice, laughed with me, and promised to have the error fixed.
Problem: at 5:30 our doctor phoned. The error can’t be fixed. Once information is in an electronic chart, it can’t be changed. What kind of numskull programmer doesn’t recognize the need for fallible humans to make corrections to typos?
Imagine getting a statement from your financial institution and finding that a decimal was in the wrong place — that the check you wrote for $50 went through as $500. Nobody would accept the bank saying, “Sorry, but once something is in the computer, it can’t be changed.” Or what if your deposit was credited to another person’s account? This happened to us once – fortunately my spouse keeps all deposit slips and checks them against the bank statement; it was relatively easy to resolve the problem because banks can make corrections to bad data.
It is possible to leave a trail showing that a correction was made: when, why, by whom, etc. The programming should then make it impossible for the old “bad” data to be copied and carried forward into future notes and communications.
In fact, the same programming would directly address misdiagnoses. Once a diagnosis is determined to be inaccurate and the true problem is discovered, it would not be difficult for a small addendum to appear throughout the chart whenever that misdiagnosis occurs, noting that on such-and-such a date, it was determined that the dx in question was more accurately replaced with a diagnosis of ___. The programming needs to ensure that the correct information, not the erroneous data, is what carries forward.
Electronic Health Records – a great idea in theory, but an abysmal failure in practice – have been inflicted on this country by the lawyers in DC who wrote the “Affordable” Care Act thinking that it’s appropriate for politicians to tell doctors how to do their jobs. There are too many problems, from poor design, to bad programming, to the tendency to perpetuate inaccurate data.
All computer software need to be well-designed. It needs to be tested and idiot-proofed. Electronic health records are no different. EHR software needs to acknowledge that fallible humans have a need to correct errors. It’s true at the bank, and it’s even more true when people’s lives are at stake.