South Florida Hospital News
Tuesday February 18, 2020

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October 2015 - Volume 12 - Issue 4



Cross-training Needed Between IT Providers and Clinical Providers

The practice of medicine is, at its core, a mix of the arts of radical problem solving, storytelling, and advocacy. How patient information is presented and manipulated through an electronic health record (EHR) directly impacts clinical decision-making and patients’ well-being -- it’s the medium and the language in which the story is told.
I am presently halfway through my medical residency - the time when new physicians apply the lessons from years of education and develop their clinical experience and bedside manner. We cycle monthly through different specialty services across several hospitals, changing roles overnight for three to seven years (or more), often across several hospitals and health care systems. Each has their own IT ecosystem, password policies, and EHRs with different templates and workflows.
On a good day I can look at a patient’s EHR chart and see a decade of labs and progress notes spanning a dozen states and numerous inpatient and outpatient encounters, using this information to aid my clinical decision-making and focus attention on the most important person in the room -- the patient. On a bad day, I’m unable to treat an unstable patient in front of me due to technical problems such as VPN errors, expired passwords, or expired SSL certificates, and hours on hold with the hospital help desk. When trying to order a Tylenol for a patient with headache, I lost count after 52 clicks, several pop-up warnings (including one that she had lost 0.01kg during her hospital stay and that this was not clinically possible), and typing two different passwords.
The act of providing patient care in 2015 frequently feels like the Internet of 1995 -- a hodgepodge of user interfaces and templates, disjointed systems and pop-ups on a desktop workstation, distracting from providing quality patient care.
Physicians, much like hackers in any other field, are world class goal-oriented radical problem solvers. I stand for my patients’ dignity and wellness, and when technology does not serve that goal it becomes the problem, just as harmful to my patient as a stroke or untreated infection. I’ve learned workarounds for EHR bugs from other residents that could be the topic of an hour-long talk at DEFCON. Information security is a fundamental part of patient care, and that a shared password or unsecured workstation may be just as deadly to a patient as a hospital-acquired infection from unwashed hands.
While we can manage almost all other aspects of our professional and personal lives from our smartphones and tablets, tasks for our patients’ care and our daily clinical workflows are too frequently chained to a desktop PC. Templates optimized for mobile environments and for the unique character of each clinical environment would benefit providers and patients.
IT providers should be encouraged come to the clinics, wards, and intensive care units to see the problems from the bedside. Cross-training between the clinical providers and IT providers must be encouraged if we are to address these challenges to our patients’ wellness.
Our patients deserve these acts of radical problem solving.

Dr. Kaylesh Pandya can be reached at

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