Learning curves and light days: notenoughworkosis

Some say that I’m a quick learner
I know I’m an EMR spurner
But I’m feeling much fresher
With a little time pressure
And the EMR they call Cerner

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.

Any introduction to a new system involves a learning curve, involving time necessary to acheive fluency and efficiency. The overall system here involves little difficulty outside of the electronic medical record (EMR) systme). I had a passing acquaintance with Cerner, the product they use here,back home, where I hated, loathed and despised it.

I try my best not to fight it. All EMRs are built by people who don’t talk to doctors, and are purchased by people who don’t take care of patients. The ideology that gave us the Palm Pilot could give us better systems.

But the administration here, recognizing the EMR’s steep learning curve, scheduled me very light for the first couple of weeks, about one patient an hour. I’ve preogressed enough that in the last two days I have had double-bookings once an afternoon, and even asked my nurse to start poaching patients out of ER and the Fast Track.

My first afternoon patient didn’t show, nor did my second. I said to my nurse, “When too many patients have noshowitis I get notenougworkosis.”

I looked forward to my last three patients. I taught myself how to put a lab order into the computer before the patient arrives. Sure enough, the result came back abnormal enough to justify hospitalization just as the nurse readied the other two patients (family members).

I had to learn the process for admiiting patients, even more Byzantine than the usual order process, and I had to do it while the other two patients waited. So I had time pressure for the first time since October 2.

I called the computer trainer, who walked me through the process. Even though he got hung up a couple times and, at the end, we encountereed a task, that, if I had done it today would have saved me time. But such couldn’t happen till next Wednesday, though that did not become clear until the trainer and I had run a number of microchip laps.

During the process, one of my colleagues, frustrated by the anti-ergonomics, fumed that seeing the patient took 15 minutes but putting the orders into the computer took 45. And I couldn’t quarrel with him. We talked about opening up a practice with paper records and charging $50 a call.

Eventually, I got the sick patient admitted, the order into the computer, and the other two patients seen. I put lab orders in for both the inaptient and outpatient side. At the end, 3 patients took me 90 minutes. And trying to get three people taken care of simultaneously stressed me out. But I liked it a lot more than the thumb twiddling I’d done in the beginning of the afternoon.


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