I was at a locums assignment yesterday using FEEMRS. (You know, “Fancy Expensive Electronic Medical Records System.”) It was all kinds of busy, with wait times of many hours. And as I slogged along, relearning FEEMRS after a few weeks away, I realized that it takes about one hour of looking at that screen for me to become exhausted.
It’s just too busy. Every bit of the screen seems filled with some data, some field, some time-stamp. Oddly, I struggle to find the triage note, the home medications, the history. I struggle to find whatever orders I have entered and to see if they have been completed. I throw my hands up trying to discontinue orders, and I nearly weep when it’s time to discharge a patient, a process which takes far too long with various orders, time stamps, discharge instructions, medicine reconciliations, printer selections and all the rest. Honestly, it’s far easier to admit someone to the ICU than to discharge them. At least in terms of computer time.
That’s the thing about FEEMRS. The flow is all off. Oh, it’s data rich. But it’s mentally exhausting. Too many clicks, too little useful data, not nearly enough white space.
Furthermore, there are the orders to sign and the charts to sign. And after you’ve signed them, there’s another place to sign. And if the nurse so much as helps them to the door, and enters that fact with appropriate time-stamp, “0300, touched patient on elbow at door,” well it’s going to need another physician signature to validate the elbow touching event and document that it was necessary, approved and billable.
Docs using FEEMRS across the country are daily beset by hundreds of orders that require signatures the next day; things we didn’t even know were orders. “Placed Band-Aid.” “Paged nursing supervisor for admission.”
A friend of mine was asked to sign nursing orders for psychiatric meds (psychiatric meds!), placed by nurses for hold patients three days after he went off shift. He wisely refused but was told, “It’s OK, everybody does it.”
By contrast, this year and last, I worked at TMH (Tiny Memorial Hospital and its several campuses) where I (gasp!) used paper charts or dictated to a human transcriptionist. My patient’s meds were either in front of me or one flip of paper away. My discharge instructions were a check mark away, or three clicks on a different program. And often, for orders, I checked a box and handed it to a secretary to enter into the system. In some instances, my prescriptions were written by hand (not perfect) and could be deleted or reconciled with a simple tear of the paper.
I notice, now, that when I go back to my hotel room after working with FEEMRS, I sleep poorly. No wonder. I’m clicking and looking, scanning screens and logging on and off until 2 a.m. I tell my kids to stop looking at screens before bed, or they won’t sleep well. I keep it up till the wee hours.
FEEMRS is quietly, slowly, electronically killing all of us and making us less concerned with patients than we are with fields, files, clicks, and saves.
Something has got to be done.
I just don’t know what.
Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of the Practice Test and Life in Emergistan.
Image credit: Shutterstock.com
