the blog spot

— posted by Steven Reznick, MD on March 6, 2023 (edited for space)

Spending Time With Computers

Recently I tried to log onto my hospital system’s electronic health record to check on the status of a patient. This patient is elderly, severely mentally incapacitated, and being cared for by physicians on the neurology service. Her son, a practicing physician at the same facility, had not received a return phone call from any of the inpatient physicians and wanted to know why his mom needed a lumbar puncture (spinal tap). As a member of the staff and her outpatient physician, I attempted to log into the system and answer his questions or at least find the contact information he needed to find a physician to talk to.

I WAS #16 IN THE QUEUE. WAIT TIME: 90 MINUTES

My local community hospital has recently signed on to be a member of a large regional not-for-profit hospital system. In the past I would access the hospital website and enter my user ID and password to log in. Now I must first enter the health system database using several levels of authentication to prove it is me and not some mercenary trying to introduce a virus or kidnap the system. If I enter my information correctly, a prompt is sent to an app on my mobile phone. I must access that app, and then, if I enter everything correctly, a new sign-in window appears from my local hospital.

I miraculously performed that task correctly, and the login screen appeared. I entered a different User ID and password and clicked on the “log in” tab. A new window appeared asking if I had downloaded a Citrix receiver. I clicked on the tab that said, “I have already downloaded a Citrix receiver.” It replied that it could not detect the receiver. So I chose the option “download Citrix receiver.” A new window appeared. I clicked on it, and suddenly I was inside the system.

I clicked on the patient electronic health record portal I always used, and a new question popped up asking what software app I wished to open this system with. It gave me a choice of six different ones. I didn’t know what to do, so I called the local hospital and asked for the Information Technology (IT) help desk.

Next, I was told by an automated system that I was #16 in line for the IT helpline. The expected wait time was 90 minutes. I hoped they would give me the option to leave a phone number and they would call me, but none was given. I hung up and returned to the computer screen that had given me a choice of six options. I chose number six, and the screen turned into unintelligible numbers and letters.

At that point, I quit. I turned off the computer, picked up the phone, and dialed the hospital main number. When the automated attendant answered, I pressed zero to speak to a live operator. I was connected with a different message and again pressed zero for an operator. A message came on saying all operators were busy. Several seconds later (which felt like minutes), an operator answered. I identified myself and asked to be connected with the neurology ICU. An actual human being answered the phone. I identified myself and asked for the nurse caring for that patient. She came to the phone, was pleasant and professional, answered all my questions, and promised to ask the patient’s in-hospital attending physician to call the patient’s son, who is a doctor.

What should have been a five-minute operation took at least 25 minutes, and I still need to learn how to get rid of program #6 that did not work and find which program will.

When I used to make hospital rounds pre-millennium, I would spend 10-20 minutes with a patient and a few minutes documenting the visit in the chart. I understand why hospital-based physicians complain that they have no more than five minutes to spend at the bedside because it takes 15 to 20 minutes to document those five minutes at bedside. There has to be a better way!

Steven Reznick is an internal medicine physician