HEC

With all the acronyms and CorporateSpeak in the health care industry these days, I sometimes wonder if any of us health care workers will ever speak in plain, unabbreviated English again. From the look of the work place project in which I am now involved, it doesn't seem so.

Our ER is preparing to change from a paper-based patient charting system to an electronic medical record (EMR). The project is called HEC (Healthcare Electronic Charting), and the program template that has been presented to us by the corporate provider (to remain nameless for obvious reasons) is filled with acronyms and some very bad grammar. The corporate representatives (I call them THEM) don't seem to be bothered by this.

Both of these facts, that the template is so poorly written AND that the corporate people don't seem to care, infuriate me. Together, THEM and a group of my co-workers and I spent two days looking at the template, THEM doing their corporate slap and tickle and me getting more and more frustrated the whole wasted time.

When I was a college professor (see entry 8/25/2007) I was sometimes confronted by students who did not think I should correct their spelling, grammar or punctuation because, after all, "this isn't an English course." Apparently, I was one of those mean, unreasonable professors who demanded students be as accountable for the accuracy of their expression as for the quality of its content.

I'm finding similar problems in the HEC project.

The most important issue I see in contemplating and preparing for a change from paper to computer charting is whether or not the electronic medium will improve charting. Two subcategories of this issue are efficiency and quality, and therefore, two questions need to be answered positively.

1) Will electronic charting increase the ease and speed with which charting is accomplished and a completed chart generated?

2) Will electronic charting improve the quality of charts in terms of accuracy and precision?

It is interesting to consider technological development in health care for a moment. Some technologies accomplish the former (efficiency) without affecting the latter (quality). Dictaphones are a good example. Doctors can dictate their charts easier via the device, but the quality of the dictation is only as good as the doctor's ability to communicate.

Other technologies can do both. Automatic sphygmomanometers (blood pressure measurement devices) enable nurses to take successive blood pressure measurements easier (i.e., remotely) and more accurately because of the elimination of subjective differences among human operators.

Will electronic charting accomplish both?

Given what I've seen of HEC, the system has tremendous potential to increase efficiency. Potential. What has to happen is THEM have to stop their corporate mucky-muck yucky-yuck and begin to examine the work methods and rhythms well-established in our ER, what THEM call "nurse work flows" (and I wonder if the mean "floes?"). So far, this has happened minimally, and when I called this to their attention, they looked at me as if I had two heads. Then, relenting a bit, responded in a shocked tone of corporate voice, "That's a good idea."

Glad I thought of it. When do I get paid?

However, also given what I've seen of HEC, I'm not certain that the program will improve the accuracy of charting. Call me anachronistic, call me a language Luddite, but I sense the electronic format THEM have provided us ruins the ability for nurses to express themselves accurately by constraining them to badly worded (and sometimes badly spelled) pre-established charting responses.

One small example.

The template allows us to indicate the Informant who provides the nurse with information about the patient. Informant. Singular. All of the response categories are also consistently singular with one peculiar exception: Parents. Why this is the only plural response category I have no idea.

Do THEM assume that when patients come in with Parent(s) that they always come in with both? In this day and age? Rampant divorce. Custody issues.

I requested that the response category be changed to singular or an S in parentheses be used, and allow the nurse to further indicate whether or not the Parent(s) is/are mother, father, or both. I even thought it might be important to indicate biological versus social parents.

I was told by THEM that the template could not be changed in this way at this time, but in the next version the change will be considered.

I cannot believe that I was they first one to raise such an objection!

Okay, it seems small, but the ramification is that we will be generating potentially inaccurate charts, charts that are considered legal documents! I can't imagine why any health care organization would willingly do this.

We'll see how things turn out. Until then, sitting in meetings with THEM, I feel like I'm really in HEC.