Computers, Medicine, Usability, viewed from the ED
If you're new here, you might like to look through this introduction to the site first.
Are you interested in how computers can reduce medical error?
Did you know that many early medical computer systems increased medical error? (Some current ones, too.)
From your own experience with your own computer at home, do you think that some computers and programs crash on a regular basis? Do you think that most software is hard to use, rude, and frustrating to work with? Based on experience, what you’ve heard, or simple extrapolation, do you suspect that medical computer systems are even worse?
Did you know that the best place to test medical computer systems is the ED, because people working in the ED don’t have the time to deal with bad computer systems, and are intolerant of BS? (If it works in the ED, you can make it work anywhere else in the hospital.)
Do you want to learn more about how to make medical computer systems usable, so as to prevent medical error?
If the answer to any of these questions is “yes,” then read through the Medical Computing series. Although looked at from my viewpoint in the ED, it all applies to medical computer systems wherever they are used, in a hospital, in a clinic or in an office.
If you need a backgrounder on Healthcare IT concepts and terminology, see Healthcare IT in a Nutshell.
There’s also a series of “word” essays that focus on particular and generally more advanced medical computer issues.
To keep up with new postings, you might want to subscribe to my RSS feed.
One final note: Once explained, most of the suggestions on this site seem simple and obvious. But as one is creating a program, or even as one is using a program with a high level of frustration, they are still not obvious until pointed out.
I hope you find the site informative and, perhaps, a bit mind-expandingly entertaining.
Keith Conover, M.D., FACEP
The following historical account is based on personal experience as a child being taken to ERs in the 1950s, as an observer in ERs in the 1960s, an EMT and then street medic training in ERs in the 1970s, and then as an emergency physician since the 1980s. Some names may have been changed or ambiguated to protect the innocent (or guilty).
1950s Emergency Room
In the 1960s and before, the emergency room (“ER”) was just that – a big room, with some curtains to divide the stretchers. The ER was staffed by a nurse or two, and at the bigger hospitals, there would be more nurses and an intern or two, and maybe an upper-level resident would supervise from time to time. There was no standard of care, nor any quality improvement (QI) processes.
Emergency Room circa 1924
Gradually, medical technology improved, and we could do more (a lot more) for patients, especially in the acute setting. Primary physicians started referring (and deferring) patients to the ER rather than seeing emergencies in the office; indeed, now that emergency medicine is a specialty, many primary care doctors don’t think it’s appropriate for them to care for anything except minor emergencies in the office. Primary care doctors now don’t leave time each office day for add-on emergencies, as they used to back in the 1950s and 1960s. And ERs gradually morphed into busy, high-tech EDs, with lots of patients, and with nurses and doctors who specialize in emergency care. A standard curriculum in emergency medicine evolved, as well as postgraduate emergency medicine residency training programs for MDs and DOs.
But EDs became so busy that they made the job of an Air Traffic Controller look easy. And, as with air traffic control, specialized management tools evolved. Read the rest of this entry
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