I don’t think many physicians would disagree that EMR usability is a patient safety issue. And yet, health systems seem perfectly happy to place 100 percent of the blame for any glitches on physicians.
I was recently involved in a situation where a physician was being blamed for an obvious system error. The physician in question is an experienced and dedicated pediatrician, well known in the area for her compassion and expertise. This physician recently performed a routine pediatric wellness check.
A look at the records (EPIC) indicated that several vaccines were required. The father was in the exam room with the patient and indicated that he would want to check with the mother before approving the vaccines. Mom was called and agreed that the child should receive the vaccines.
When dad and the patient went out to the waiting room, however, the grandmother questioned why vaccines were necessary, since she was quite sure that the child was up to date on all required shots. Sure enough, after an exhaustive search through EPIC, a record of previous vaccination was found. This record was a PDF, and had been placed in the “media” section of EPIC.
A complaint was made by the family. The health system promptly leapt into action. Someone without experience in the health care environment would no doubt assume that the hospital promptly began a review of its systems to assure that future vaccine records would not be lumped into a folder that nobody was likely to look at. An apology to the physician for the obvious systemic error might also be expected.
However, as most readers of this blog probably already surmised, this was not what happened. Instead, the physician was formally counseled on a failure to comply with the health system’s vaccine policy. Even more incredibly, the health system was on the verge of placing the physician into a corrective action program so that the egregious error committed (by the physician, of course; the health system obviously viewed itself as blameless) might never happen again.
As noted by the article cited above, problems like this are not training issues. This was quite obviously a systemic issue that should have been corrected at the administrative level of the health system. If Marcus Welby, MD (of the eponymous fictional television show of old) were using EPIC, he might have found this entry. Of course, Marcus would have spent an hour or so with the patient. Physicians on the modern assembly line of corporate medicine do not have the luxury of time to peruse every nook and cranny (no matter how seemingly irrelevant) of the record.
The result of this debacle thankfully should not harm the patient. Booster shots may not have been needed, but they probably will not hurt.
However, the physician and the community she serves were victimized. Facing the potentially ruinous effect of a corrective action plan in her file, the physician chose to resign. Thanks to the covenant not to compete in her employment agreement, she will probably never see any of her patients again. The community lost a cherished physician. The physician, after decades of service, will be moving on and starting over.
This is obviously not how this situation should have played out. A patient safety issue was identified. Instead of ensuring that this could never happen again by training administrative staff how to properly enter information received, the one physician (so far as we know) who discovered the issue was blamed for the result.
If the Federal Aviation Administration were run by the people running the U.S. health care system, air travel would be extremely hazardous. Whenever a bad outcome was observed, we would simply “fix” the issue by punishing the pilot involved. In the short term, this is much cheaper than fixing the problem that caused the issue. The long-term implications, however, would be frightening to anyone flying the “friendly” (and ever-profitable) skies.
The ramifications of a refusal to deal with EMR issues are equally frightening. Physicians are smart and dedicated people who are constantly striving to do the best for their patients. History has shown that we can continually keep piling on the responsibilities and the physicians will somehow make it work. However, there are practical limits to this approach. By denying physicians the tools they need to treat their patients, we cannot expect these physicians to provide the best quality care.
However talented the physicians they hire may be, health systems must recognize that these physicians will not produce the best care unless they are provided with appropriate tools, and appropriate time to utilize these tools. Instead, it seems that the health care system will continue to expect the best from their physicians, even if they are working under the worst conditions.
Dennis Hursh is a veteran attorney with over 40 years of experience in health law. He is founder, Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be found on YouTube and LinkedIn.
Dennis is a frequent lecturer on physician contracts to residency and fellowship programs and has spoken at events sponsored by numerous health systems and physician organizations, including the American Osteopathic Association, the White Coat Investor, the American College of Rheumatology, the American Health Law Association, and the American Podiatry Association.
Dennis has authored several published articles on physician contractual matters on forums such as KevinMD and Medscape. He is also the author of The Final Hurdle – A Physician’s Guide to Negotiating a Fair Employment Agreement, which is considered the go-to resource on physician contract negotiation.
