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Wednesday, April 10, 2013

Playing Where's Waldo with the medical record

There is nothing worse than trying to function and make decisions without access to relevant information. Sometimes that takes the form of a sick patient showing up on your doorstep without the benefit of any reliable medical history. Almost as bad (and perhaps sometimes worse) is someone showing up with the equivalent of War and Peace volume of non-indexed records and an expectation that I review them on the fly and render the definitive opinion within a few short minutes. Did I mention that they had leveraged their life savings to travel from half way across the galaxy to see me only to be scheduled in that generous 15 minute slot?

Yes preparation and information are critical for being in a position to make rational and likely helpful recommendations to patients. Thank God we are on top of this with our electronic medical record with ALL of the relevant information at my beckon call. Not so fast....

Perhaps the only thing worse than no information is a sea of information, and no real way to effectively search and identify what is important and relevant. I was overseeing a resident clinic today and saw a patient with a confusing presentation which perhaps suggested some sort of multi-system disorder which could heart, skin, kidney, or GI tract. We sent searching for relevant studies, first focusing on a cardiac echo. Would I find it under reports? imaging? cardiac? Did he have it here or was it an outside study and could it be one of the sea of scanned documents organized chronologically by when someone got around to scanning it? Is there any sort of reasoning behind how they are labeled or titled? Who am I kidding?

As I am clicking on every imaginable tab and folder, I have a flashback to when my children were younger. We used to read books of the "Where's Waldo" series, particularly at bedtime. They would chose the WW books because they knew they could defer the lights out hour almost indefinitely because it would take forever to find Waldo in the sea of figures he was hiding in.

That is where we are with the EHR. We have created the Where's Waldo equivalent. No real index. No real search function. Just rare morsels of critical information required to make good decisions hidden in a sea of useless distracting medical noise. Where's Waldo?????

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