It would be tempting to say that technology is what’s driving our practices these days, so woe be to the physician who refuses to get with the program.
But while technology has changed virtually everything we do in our practice (and much of our life), the challenge and frustrations we face, I believe, lie more with “get with the program” side of the equation, not the technology-driven changes themselves.
If we look at the technology side, there is a lot to like. Frankly, I’m surprised at how many of my colleagues have never logged on to our new online order system, Carecast. From any workstation at SHC — I’ll get to offsite access in a minute — I now see at a glance if any of my patients have been admitted, and if so, where they are. When I check on either an inpatient or outpatient, I find out immediately if any new radiologic studies are available. And when it comes time to sign a verbal order, I don’t have to look up — the order to sign is right there on the screen ready for electronic signature.
I realize that many of us who learned to use technology at midpoint in our careers have experienced a learning curve. But is that really any more frustrating than searching for a lost chart, making multiple phone calls to find a patient, or deciphering the handwriting of a colleague’s critical chart note?
I don’t think so. The frustration comes from being told that we must learn to change our behavior. It’s tempting to rationalize that the people assigned to help us change “don’t understand.” To make matters seemingly worse, these bearers of news, often IT and not medical professionals, also tell us that in the new order a friendly (or obsequious) nurse or admin person is no longer going to be available to scurry around looking for that chart or order sheet you need to sign. That sort of activity must stop when we go later to the next step of online management, the Epic electronic medical record system.
These experts are telling us for good reason that we must now become fluent using Carecast, because when the comprehensive Epic system arrives, we will no longer be able to maintain a two-tier system of chart management, at least in part for security reasons. Our online logins and passwords convey the authenticity and security of our own penned signatures. We can’t compromise that by asking our staff members, a housestaff member or another member of the caregiver team to log-in on our behalf.
Moreover, in a world where efficiency creates survivors, we no longer can afford the luxury of tying up support personnel to provide amenities that our younger colleagues no longer even recognize as amenities any more.
So, yes, we are all being told what to do, and we need to make that transition ahead of the curve before old fashioned, paper-based alternatives are not just an anachronism but are in fact substandard or even impossible.
Right now all physicians need to sign on to Carecast every day, or at least every other day, to see if they have any verbal orders assigned to them for signature. These can be cleared with a click of the mouse after Carecast recognizes it’s you who has logged on.
I’m bringing this to your attention and asking for your support, because the joint commission is now requiring SHC to sanction medical staff members who repeatedly fail to sign or electronically acknowledge their verbal orders within a required 48-hour window. To implement this requirement, the Medical Board has passed a new policy requiring outliers to complete an online training course, that will cover, among other things, the reasons why it’s important to sign orders promptly. I personally believe if we all understood those reasons, we would all be in compliance. And we all do have the opportunity to avoid that training course by logging in and signing in our orders at least every two days.
A similar course will be required of practitioners who are unable to stop using unapproved abbreviations. There are now five abbreviations which in thoughtful studies across the country have been shown to be confusing and potentially dangerous for patients. No matter how long we have used these comforting symbolic icons, it is time to stop. [See a list of the unapproved abbreviations and safe alternatives].
While a remedial course is certainly not the first line of defense to correct either of these issues, the fact is that JCAHO has become rather impatient with our promises to “educate” our staff regarding the use of unapproved abbreviations and seems to be anticipating our need to have something in place to ensure that verbal orders will be signed electronically.
To improve compliance with these safety mandates, and to prevent institutional sanctions, the Medical Board has adopted a policy that physicians who repeatedly use unapproved abbreviations will meet with and face sanctions from their service’s quality assurance committee, and then if use continues, from the hospital Care Improvement Committee (CIC), formerly the Care Review Committee.
Serial abbreviators will also be mandated to take a web-based course about unapproved abbreviations. (This course, by the way, will be developed in-house and be available to medical staff through Healthstream, an organization with a fine track record of providing regulatory continuing education courses for our own employees at SHC.) Modules may be completed from any computer with Internet access at the user’s own speed and schedule. We will be able to track completion and evaluate results using online quiz results.
Meanwhile, the hospital is doing everything it can to use this time of change to make information and chart management easier for physicians to use. Epic is expected to produce some long sought after enhancements. We will be introducing a new dictation system that gives us the ability to edit and electronically sign our notes online and dispatch letters to referring colleagues almost seamlessly in advance of the Epic rollout.
While Carecast is now easy to use from inside the Medical Center, we are also working to increase access from private clinician offices, your homes, or your laptop while traveling. But right now, logging on from your office or home computer does require some advance planning. Without becoming too technical, you must have a computer configured with special software to allow access to the network. This is commonly called VPN for virtual private network. Alternatively, you can log in from almost any terminal using your password through an ultrasecure internet system (called a key fob for you techies). The package, supplied by the Citrix Corp. of Florida, is similar to the ID systems now used by banks or other internet sites where you are asked to identify a series of letters in script to show that you are logging in as an individual — not generating a computer-based password or access scam.
Currently with either of these approaches you can access Carecast and obtain lab data, see transcriptions and sign verbal orders remotely. Kevin Tabb, our physician chief quality/medical information officer, is currently investigating a handheld device that would allow you to dial into your medical records using cell phone networks. We will keep you up-to-date as we learn more about these emerging technologies that I think at the end of the day will make our practices much easier.
Meanwhile, we need to do our part. We all will need to put our egos aside and make the necessary adjustments if we are to continue to serve our patients. Our leadership — and perhaps even our own egos — depend on our being successful.
