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Saturday, August 15, 2009

Training the EMR: A Case-Based Perspective - The Patient's Point of View

Part Four of a Four-Part Series

I thought I had completed my 3 part series on Training the EMR:
But then, as fate would have it, I landed back in the middle of it with an unexpected trip to the ER this summer.
As mentioned in the earlier articles, I spent 8 weeks as an EMR trainer at a new hospital in our county. The new hospital used Cerner software, but my intent in writing the series was to apply/discover principles that could apply to training an EMR in general.

Anyway, back to my story. A few years ago my husband and I fulfilled a life's dream by acquiring three acres of land with a 100-year-old farmhouse and two newer pole barns where he could work on antiques and have horses. While the house had been kept up very well (for its age), it was in need of a new roof - so this summer the old gal got a new "do." :)

We had contracted with a German Baptist gentleman in a neighboring county and so were rather surprised when a team of four Mexicans showed up to do the work. Extremely hard-working and agile, they managed to take the old shingles off our steep roof and put the new shingles on in a day and a half. This included a trip to the emergency room about 8:00 p.m. the first day when one of them slipped and got a splinter that went through his palm by his little finger and protruded out of the back of his hand -- Ouch!

I'd like to make a little detour off the subject here - just long enough to
mention that during the summer months, when the sun sets at 10:00 p.m., 8:00 p.m. is
waaay too early to close the Urgent Care Clinics which are part of the health care system in our area.

I have no criticism of the ER staff other than the length of time it took to get around to actually removing the splinter. They put us immediately into a room - and didn't fiddle-faddle-dawdle around about insurance. Which is what you would expect of a patient-centered facility. They made a valiant attempt to communicate with the injured young man who didn't speak English, as they tried to locate a translator. They were humorous, professional, and reassuring - and likely happy - not for the calamity, but for the business.

As I watched the nurse do the intake and initial assessment and medication reconciliation, I thought back to my training stint and tried to picture the computer screens she was working with - even though I hadn't dealt with Cerner's ER module.

I could also tell that the young man was starting to be in quite a bit of pain. As the clinician sat and gazed into the computer with furrowed brow and worked through the questions, he sort of looked at her puzzled - as if to say, "Yoo hoo, I'm over here." Then he glanced over at me and smiled and shrugged.

In all fairness, time often seems to move slower in hospitals - at least from the patient's - and family's perspective. My own term for this phenomenon, coined from various experiences with friends and relatives through the years, is hospital time. Actually, since my EMR training, I now know there truly is such a thing - it's referred to as the standard medication administration schedule and Cerner allows half an hour to fifty minute window before a dose is considered to have been missed (if I remember correctly). Anyway, noting that my young roofer friend was not being actively attended to, I asked a nurse if he could at least have an aspirin or something for pain (because I know firsthand what a bad splinter feels like - and I was starting to get sympathy pains just looking at him).

"Of course," she said. And of course he got it - in hospital time. But eventually they got him all fixed up - and he was back at work the next day!

Reflecting back on this experience, it's easier for me to understand the resistance some healers may feel toward an EMR. Despite all the ways devised to make them unobtrusive - stationing computers outside each patient's room, having WOWs (Workstations on Wheels) and COWS (Computers on Wheels) on the units, and having clinician work areas behind the nurse's station, computers still seem to insert themselves between the healer and the patient at, well, inappropriate times. Or so it feels. Educationally, this concern is reflected in the comments and requests voiced by my students. They wanted access and practice time outside of class to get to know the forms they were going to use - because, as more than one person said, they did not want to appear to fumble in front of a patient.

It's a legitimate and professional concern - and I don't know entirely what the answer is, other than to give clinicians as much access as they need during the training period for them to feel comfortable and facile with the EMR. This would include manuals, and access to simulation tools outside of class - both at work and at home. Perhaps my readers may have other suggestions as well.


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