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A typical day on the ward

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Re: A typical day on the ward

#31

Post by ACow_Adonis »

jvdh wrote: post #29
ACow_Adonis wrote: post #26

Earlier quoted context omitted.

I dunno about the "always works" claim. I have nothing to do with health care, per se, but I always tell everyone to factor in a base 1%-5% error rate for basic information and data entry that a human beings end up doing manually... I imagine the number of errors/deaths/kerfuffles due to the opportunity cost of professional time, not to mention transcription and human errors of such systems are not inconsequential...…

You are never going to take away the human from this equation. Notes are taken over the course of the day, and many of the proposed systems end up taking more time: nurses do their rounds, use pen and paper to take notes while walking around, and at the end of the shift copy the notes from the paper into the system. This means that you have basically added another data entry level, increasing both time and error rate…

Well I can't comment on the system/app offered by the author of the OP, but obviously the point of designing a system to fix/improve such operations wouldn't just be adding another level of data entry and subsequently multiply risk, but instead to minimize it.

The goal is not to remove humans from the equation, since that is probably both impossible and undesired, but to separate humans and computers into supporting each other in the task at hand by specialising into what they do best: computers for tasks that can be broken down into repetition, replication, automation, speed, validation, and volume, and humans for creation, ambiguity, complexity, context, service delivery and interpretation.

At the moment i'm guessing there's a fair bit of humans doing the jobs computers are good at in hospitals around the world...

Re: A typical day on the ward

#32

Post by konzi »

I would love to have a list of tasks for each of my patients on my phone. This would make being an intern far easier. In fact, I'm currently validating and building a solution for this exact problem, which I will talk about below, but first it's important to understand what an intern (at least here in Australia) does during the actual ward round where most of their tasks for the rest of the day are created.

An average intern during a ward round has to do the following things for each patient : 1) Handwrite notes into the patient's bedside notes as the senior doctor takes a history / examines the patient. 2) Look at the patient's vitals chart and medications chart. 3) Handwrite a plan in the patient's notes at the end (this is essentially a list of tasks for the intern to do during the day). 4) Often while the intern is still writing the plan, into the patients notes, the rest of the team is already moving onto the next patient. The intern will hurriedly re-write any tasks from the plan onto their personal printed patient list (takes Now Listrunner, in their demo video shows a list of tasks for each patient on an iPhone. Awesome!

But where in the ward round does my list of tasks get copied into Listrunner? If I have to manually find the patient in the app and then manually add the tasks to an app it would take minutes, not the I've been thinking about this a lot, and I think a solution using google glass would be super amazing here. I'm currently in the prototyping and validation stage of the project (following Eric Reis' 'build-measure-learn'). Happy to talk to any doctors interested in it.

It works as follows:

1) After you finish writing the patient's plan you take a photo of it with google glass. 2) OCR is performed on the photo, right then an there (hopefully in The advantage of this system is that it doesn't change the current workflow at all. It doesn't affect the speed of the ward round. Thus, faces a lower level of resistance to adoption.

Disadvantage - doctor's are notorious for bad handwriting, thus it will not work for all doctors. It's expensive. However, as google glass (and perhaps other similar tech) gets cheaper this may not be significant.

*Patient labels are already affixed to the top of the page (so OCR can be performed on the label to associate the tasks with the patient). But if the solution became widely used, a simple QR code could be added to patient labels, to make this easier.

Re: A typical day on the ward

#33

Post by tomwalker »

JoshMandel wrote: post #11

When I was a med student in 2009, I did my surgery rotation at a community hospital outside of Boston. Each morning two students were responsible for copying down overnight vital signs from the EHR onto paper. The job took upwards of 45 minutes, and morning rounds were at 6am... I didn't mind driving through icy Boston roads at five in the morning -- but I did mind the fact that I was doing a job that computers shoul…

This is an area that liability is called into play. If the wrong details are printed out for a patient and a bad decision was made based upon them, then you probably know what a hard time you would have had.

It is fantastic to see that you are working to help fix the problems!

Re: A typical day on the ward

#34

Post by riahi »

JoshMandel wrote: post #11

When I was a med student in 2009, I did my surgery rotation at a community hospital outside of Boston. Each morning two students were responsible for copying down overnight vital signs from the EHR onto paper. The job took upwards of 45 minutes, and morning rounds were at 6am... I didn't mind driving through icy Boston roads at five in the morning -- but I did mind the fact that I was doing a job that computers shoul…

Meditech?

Re: A typical day on the ward

#35

Post by daigoba66 »

anigbrowl wrote: post #7

After a 12-hour stay in the ICU a couple of years ago, this doesn't surprise me in the least. I was given a different patient's discharge papers by mistake, and when I got all the records of stay for reference afterwards some of the clinician's reports were utterly illegible. I guess this is why I ended up answering the same medical background questions over and over again during the night. - This looks like a great…

Minor nitpick: it's HIPAA, not HIPPA.

Re: A typical day on the ward

#36

Post by Loughla »

vacri wrote: post #14
anigbrowl wrote: post #7

After a 12-hour stay in the ICU a couple of years ago, this doesn't surprise me in the least. I was given a different patient's discharge papers by mistake, and when I got all the records of stay for reference afterwards some of the clinician's reports were utterly illegible. I guess this is why I ended up answering the same medical background questions over and over again during the night. - This looks like a great…

As a medical technician in a neuro department, I had to take an illegible referral to the neurologist who wrote it (luckily he was in-house). Even he couldn't read his own handwriting: "But I know the patient, and he needs...".

So maybe instead of adding a layer of technology and all of the costs, privacy concerns, reliability concerns, etc., all that's really needed is basic handwriting training, practice, and expectations of legibility for doctors.

Something, something razor.

Re: A typical day on the ward

#37

Post by leonth »

konzi wrote: post #32

I would love to have a list of tasks for each of my patients on my phone. This would make being an intern far easier. In fact, I'm currently validating and building a solution for this exact problem, which I will talk about below, but first it's important to understand what an intern (at least here in Australia) does during the actual ward round where most of their tasks for the rest of the day are created. An averag…

I don't think OCR will work that well in this case. Assuming the OCR is able to detect the letters, at least from my experience, they like to draw stuff, write things in uneven 2-column or 3-column format, and make use of shorthand symbols.

> the OCR is shown to the google glass wearer who can confirm that the OCR is correct.

This takes a LOT of time. For a page of patient note full of lab values, one needs to make sure each number is translated correctly. And if something is wrong, how do you expect the wearer to fix the OCR results on the google glass?

Price wise, I would think 1 or 2 google glass would be much cheaper than a real EMR system.

Re: A typical day on the ward

#38

Post by leonth »

The article glosses over the fact that wards rounds are typically an exercise that requires vast amount of highly dimensional data. Hidden in the article is the requirement that the information - lab values, vitals, patient location / status, problem list - must be maintained electronically. This by itself is already very hard, especially as paper records never have downtime / network issues and do not talk back when invalid values are written.

Please be assured that the state-of-the-art is not as described. Sufficiently advanced hospitals would have means for healthcare workers to access vitals, lab values, patient location, current medications, current problem list / diagnoses, medical history from previous days and even previous visits, and even medical history from other institutions - all electronically. Staffs enter data into system directly and no transcribing is required. These are available as discrete data i.e. not freetext strings only decipherable by humans.

Also don't forget about electronic prescribing of drugs, glorified vending machines with pockets that only open when there is an order for that particular medication, and barcoded medication administration system.

Re: A typical day on the ward

#39

Post by bglazer »

vacri wrote: post #14
anigbrowl wrote: post #7

After a 12-hour stay in the ICU a couple of years ago, this doesn't surprise me in the least. I was given a different patient's discharge papers by mistake, and when I got all the records of stay for reference afterwards some of the clinician's reports were utterly illegible. I guess this is why I ended up answering the same medical background questions over and over again during the night. - This looks like a great…

As a medical technician in a neuro department, I had to take an illegible referral to the neurologist who wrote it (luckily he was in-house). Even he couldn't read his own handwriting: "But I know the patient, and he needs...".

Why is this tolerated? It seems like such an absurdly basic problem to fix. Years and hundreds of thousands of dollars of advanced medical training is distilled into a note/prescription that looks like a fucking five year old wrote it. It's pathetic.

A personal anecdote: I went to a doctor recently. He opened my notes, squinted at them, and then asked me what medications he had prescribed me. That was my last visit to him.

Re: A typical day on the ward

#40

Post by phren0logy »

leonth wrote: post #38

The article glosses over the fact that wards rounds are typically an exercise that requires vast amount of highly dimensional data. Hidden in the article is the requirement that the information - lab values, vitals, patient location / status, problem list - must be maintained electronically. This by itself is already very hard, especially as paper records never have downtime / network issues and do not talk back when…

MD here. I agree that many EMRs can do the things you list. What you have missed is how painful/clunky it is to do so, which is why it's still so often done by hand.

Of course, some EMRs may be good... just none of the 10 or so I have used.

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