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President’s Letter
Me and You and an EHR
Named “System Error”
By Stephen J. Ezzo, MD
The Place: A Pediatrician’s office Daughter: I have a rash on my arms.
The Location: Somewhere, USA
The Setting: An exam room, typical of most pediatric exam rooms.There is a wood Physician: How long has it been there?
bench with a pad on it.Two chairs – one large, one small. Cabinets above and
below a counter. On one wall is a computer attached via a swivel arm, the pullout Daughter: A couple of days.
keyboard housed in a plastic enclosure.
The Characters: A physician, a mother, her young daughter, age 7 Physician: Is it getting worse?
The door opens, and the physician enters to find the mother seated in the larger chair
and the daughter sitting on the table pad. Daughter: Yeah, I think so.
____________________________________________________
Mother: Yeah?
Physician: Good morning, everyone. Good to see you again.
Daughter: I mean, yes sir.
Mother: And you, doctor. How are you?
Physician: It’s OK. Thank you. Now let me have a look. Hmm. Do
Physician: Doing great, thanks. (He puts his stethoscope and you play outside a lot?
diagnostic kit on the counter and approaches the daughter.)
Miss Josie, how are you? Daughter: Yes.
Daughter: Good, thanks. Physician: Good. You should. Better that than video games. This rash
looks likes it itches. Have you been scratching it?
Physician: Still causing lots of trouble?
Daughter: (Sheepishly.) Yes sir.
Mother: (With feigned exasperation.) Every day!
Physician: I would do the same thing. Looking at it makes me want to
Physician: Excellent! That’s my girl! (Fist bumps the daughter and scratch.
swings the computer out.) Alright. Let’s get this contraption up and
running so we can see what’s bothering you today. (Places finger on Daughter: Really?
biometric ID scanner.) Hmmm. Try again. (Tries again.) Ok, now
it wants my password, which the fingerprint reader was supposed to Physician: You bet.
bypass. (Types in password.) Great. Locked out, again. Better move to
another room. Daughter: (Somewhat triumphantly.) See Mom, I told you it’s OK
to scratch!
Afewminuteslater,theyareinanotherexamroom,similartothefirst.
Physician: Well, a little scratching is OK, but a lot actually will make it
Physician: OK, take two. Come on, you can do it, I have confidence in worse. I’m going to give your mom a cream she can put on it to make it
you. Open the pod bay doors, Hal. Hey, we’re in! Well, not quite. This go away. You’ll let her do that, right?
is just today’s schedule. Need to open her chart.
Daughter: Yes. Can I still go out and play?
Mother: I never realized you were using the same computers we have
at my office. Physician: Whenever your mom says it’s OK, and I think she will.
(Turning toward mother.) This appears to be some type of contact
Physician: Good one. I need to remember that. Oh, they certainly make irritant rash, just like you thought. Let me put a few notes in the chart.
our lives easier now, don’t they? At least, I am told. I find if I don’t do it when I see the patient, I don’t recall all the details
later, and the note is not as complete as it could be. Must have to do
Mother: I hear you. The recent upgrade we just had? Well, let’s just with getting old.
say that we still haven’t gotten back to where we were beforehand. But,
I imagine this saves you lots of paper though. Mother: Certainly. Take your time. My doctor does the same thing. It
makes me feel like he is listening to everything I say.
Physician: You’d think, but no. By the time we print your after-visit
summary, along with any patient info, we’ve felled a couple of small Overthenextfewminutes,theH&Pthesystemfreezestwice,requiringre-enteringof
trees. But at least the pharmacist can read my prescriptions, and I can passwords,etc.
read my notes, so that is an improvement. So Josie, what’s going on?
Physician: (Typing.) OK, diagnosis. Contact dermatitis — there it is.
Nope, can’t put just that in. They want location — extremities. Acute or
chronic — acute. Secondary infection — none. Environmental or other
— environmental. Initial encounter or subsequent — initial.
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