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    Sunday, March 13, 2005

    When Medicine and Technology Collide: More on making computers work in medicine, from readers and from bloggers. From a resident whose hospital uses PDA's instead of tablets:

    We have a very similar system to the one you describe,
    except instead of tablet PCs, it uses our PDAs. It takes about a
    minute to sync at one of a dozen or so stations around the hospital,
    and you're off and running with your census list, labs, radiology
    reports, transcriptions, and (just recently) vitals. Now that it's
    wireless, you can sync anywhere, anytime if you have the right PDA,
    which I don't.

    I can't tell you how much time this saves in the morning, over having
    to run back and forth to a computer (when you can get to one) to get
    your AM labs. I wonder if your hospital's reluctance stems from the
    use of the tablets, which I assume have to be checked out, over the
    PDA, which most of us already use for Epocrates, 5MCC, and the like.

    A PDA would be a much better device for carrying around patient data than the tablets my hospital is using. It isn't cumbersome, most of us own one, and it sits nicely on top of a paper chart while you're writing. I know I find mine very useful when I download a patient's office chart from my EMR into it for hospital admissions and consults. And yes, I think that signing out the tablets has alot to do with the reluctance of people to use them. It's one extra time-consuming step in an already rushed morning.

    And medical blogger Dr. Tony notes an "advantage" of paper records over automated records for hospital staff:

    Of course, an advantage to paper records or post hoc entry into the computerized system is the ability to "adjust" the time things are done (or at least the time something is recorded as having been done.)

    Oh, so true. What doctor hasn't rounded on a patient at 10AM and not had vital signs for 7:00 AM in the chart, only to see them magically appear there on the next day's rounds? Or seen nurses notes after someone develops problems claiming they called the doctor at such and such a time when they never did.

    I stopped writing "Vital signs stable, afebrile" in my charts after reading about a malpractice case that hinged on when a patient became febrile and whether or not the doctor knew about it. I always suspected the day's vital signs weren't in the chart when the doctor rounded and he went with the latest available set of vitals. But he just wrote "vital signs stable, afebrile" (commonly, and quickly, written "VSS, afebrile".) Now I take the extra time to write down the latest vitals and the time they were taken, as well as the time I'm writing my note. Just in case.

    posted by Sydney on 3/13/2005 08:06:00 AM 0 comments


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