One of the selling points for the electronic medical record (EMR) was that it would be a boon for patient safety. Just having all the medical records in one place is a monumental improvement over the days of lost charts and misplaced X-rays. Avoiding errors from inscrutable handwriting has no doubt saved lives.

But EMRs can also worsen medical care and introduce errors. Cumbersome usability forces staff to take shortcuts that can be dangerous. Diagnosis codes that are driven by billing requirements distort the diagnostic process and can lead to diagnostic error. Copy-and- paste ability leads to voluminous notes that resemble those online “terms of service” agreements that you surely read assiduously.

By far, the biggest landmine for medical error and patient harm is the automated alert system. For doctors and nurses, these computerized alerts constitute one continuous, communal migraine. The EMR alert system has become an octopus of misery, swatting unceasingly from all directions. Just when you think you may have cleared the gauntlet of alerts, another seven bulbous legs come whipping at you with more alerts to navigate.

It makes me crazy—and livid—because buried within the morass of useless alerts are some important ones that I can’t afford to miss. Besides, the EMR is a legal document. Clicking “OK” to an alert indicates that I’ve read it, evaluated its contents, considered its impact, and then made a decision. That’s certainly what a lawyer would say in court.

I decided, one day, to commit myself to reading every single alert before I dismissed it. I set to work that morning, feeling like a boxer newly motivated in the ring, bobbing confidently, flexing my newly invigorated patient-safety muscles. I could almost feel the satiny robe glittering around my shoulders instead of my saggy white coat with ink stains from a leaky pen. I was ready for battle!

Let’s just say I didn’t even make it through the first round. I was defeated with my very first patient of the day. He needed thirteen prescriptions, and these generated dozens of alerts. Nearly all were useless.


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