(Chelsea Update would like to thank Dr. Barry Nemon, director of the Chelsea Community Hospital Emergency Room, for the information in this column.)
There are computers everywhere in the Emergency Room, but what can they do and what can’t they do?
How do they help and how do they hinder?
And what can we expect from the future?
We had computerized registration in the ER for a long time, but electronic triage is new. In triage, the nursing staff collects information about what is wrong, current medications, allergies and chronic medical problems. They also take the vital signs (blood pressure, pulse, pulse ox, and temperature) and determine on a 1-5 scale how sick you are and how soon you must be seen.
The ER physicians work off an “electronic tracking board,” which allows them to see how many patients are coming in and what their complaints are. Based on that 1-5 scale from the nursing staff, a decision is made about who needs to be seen first.
The doctors, physician’s assistant or nurse practitioner will enter new information based on obtaining a history and doing a physical exam. The clinician will then directly order new tests using the computer without using a clerk, as we did in the past.
These clinicians can also look back at previous ER visits, hospitalizations, radiologic tests and old laboratory studies to help them decide what is wrong. Looking up old information from a previous visit is one of the strengths of the new Electronic Medical Record.
We could get old charts in the past, but it took such a long time to get an old chart from a storage room. Plus, it wasn’t easy to thumb through a thick paper record and try to extract all the important information.
Patients often wonder why we ask them questions about their past history when we have the computer in front of us. And that starts some of the discussion of the limits of our current Electronic Medical Record.
What if we rely only on old records, but they are wrong or incomplete? We would all like to think that the computer is more accurate than a human being, but the computer is filled with data entered by a human being. But aside from inaccuracies, there is always change.
On the last visit, perhaps a patient did not know that he or she had an allergy. But since then, this patient had an allergic reaction to a certain medication. We need to add that information.
What about other limits of this new electronic medical record?
See you in two weeks and I will try and talk about some of those other limits.
Stay Well, Dr. Barry Nemon