On Sat, 2005-05-07 at 08:34, Jim Stuttard wrote:
> ...
> The UK Brit Med Assoc (BMA) complained the media that general practice
> (GP) primary care doctors at ~10 min per appointment resented the
> displacement of their focus away from the patient represented by
> concurrent data entry.
Once upon a time, 20 years ago, I became a (US) FAA-designated aviation
medical examiner. My nurse and I made little scribblings on our FAA
form as we worked. A healthy pilot took about 20 minutes of her time
and about 20 of mine; when we were done the secretary typed up our notes
and the certificate nice and pretty, and the airman trudged off armed
for duty.
Then the FAA, to reduce their own paperwork burden, created a database.
The doctor or the secretary now typed *all* the information on the form
into an DOS data entry screen. By *all* I mean that the airman's
responses had to by typed in as well. In order to get the airman's
certificate out the door in the same time as before, I
(a) bought a laptop computer
(b) brought it into the exam room
(c) typed his responses myself while interviewing him
(d) typed my findings after examining him
(e) printed the certficate by mounting it on a template and feeding
this through my printer.
(f) twice a month, I plugged in a modem and batched all the exams to
the FAA database.
Benefits:
The airman had his ticket the moment we were done: no waiting for
secretaries.
The software knew the certification rules, so I didn't make stupid
mistakes or leave out details.
Drawbacks:
It took 10 more minutes of my own time in the office.
(Yes, I tried having the airman enter his own data, but repairing the
damage took more time than doing it myself. And some of these pilots
are too stupid to understand how to fill out the paper form, never mind
the computer. Don't get me started...)
It came to pass that the internet became a tool, and so the FAA decided
to make this more efficient by having an on-line data entry tool, so
that the information would be immediately captured by their database.
The AME was now required to have an internet connection and a browser.
I will spare you the details; this new software was not well engineered,
and the FAA purchased inadequate bandwidth. The error-checking
vanished, one had to wade through 8 successive data-entry pages, and (it
being a browser) could not print a properly formatted certificate when
done. Back to the secretary.
With all these advances, it now took an additional 10 minutes of my time
to complete a physical for an airman with no medical issues. And
meanwhile, computers and word processors flourished, and the secretaries
have no typewriters, and the one remaining typewriter in our
institution, a fine old IBM Wheelwriter, was bequeathed to me by our
administrative secretary, who said, "I'll come get if if I need it."
The next advance in this system is to have the airman provide his data
at home via the internet, directly entering his medical history via an
encrypted page. Never mind that half the airman need hand-holding and
coaching to get the blanks filled in with the information that actually
belongs there.
The airman will then be provided a pass code to take to his flight
surgeon (that's me). We will pray that he writes it down; that he
remembers where he put the note; that he brings it with him. Then, when
we have finally obtained the forgotten pass code by telephoning the
support specialists in Oklahoma City, we will have to review his data
and separately document correction of all his errors (rather than
coaching him to do it right the first time).
Yes, the efficiencies of IT EHR are indeed wonderful. In this case, the
efficiencies are all in the FAA offices.
But I'm not complaining. It's fun and entertaining, as these are mostly
healthy folk and there's no pressure to do miracles.
Dan Johnson md
