Last week, I was traveling from my hotel to my company’s main office when my colleagues and I decided a detour for coffee was absolutely necessary. We had a five-minute trip ahead of us, and one of us (not me!) had the brilliant idea to order the drinks and food on the Starbucks mobile app so that we could get in and out quickly. Naturally, we all started shouting our orders.
“I’ll have a grande triple shot latte,” someone yelled. My tech-savvy coworker tried to quickly navigate through the Starbucks app, but . . . not so fast. There is no such thing as a triple shot latte. Turns out that’s really not a thing. You have to order a latte with an extra shot of espresso (because there are already two shots of espresso in a Starbucks latte.) That’s the same thing, right? Kinda. It’s kinda the same thing. Even though we might order a triple shot latte, the barista at ‘Bux keys in a double shot latte with an extra shot. The barista translates our order so the computer will accept it.
See where I’m going with this? Before we had electronic health records (EHRs) and computerized physician order entry (CPOE), hospital unit clerks did similar work; they translated the chicken scratch that doctors wrote in the paper chart into a format that the computer would accept. For years, a physician ordered a 4-view wrist x-ray, not realizing there was no such study. Lo and behold, the unit clerk entered a 3-view with the one extra view the doctor needed.
Nowadays, most physicians have to enter their own orders, and sometimes computers can be much less forgiving then unit clerks . . . or baristas. Some EHRs know what an x-ray chest is, but they’re flummoxed by a CXR. Even worse, they might tell a user that there is no such thing as a chest xray when the computer is expecting a chest x-ray. While most modern EHRs can deal with these minor issues, not all can, and not all that can do.
I make my living helping doctors use technology, so I’m certainly not calling for us to return to the days of paper (or pagers or x-ray studies on film!). Those days have passed, and they’re not coming back. But I do commiserate with my fellow physicians when simple things like order synonyms and consistent, usable naming schemas are not properly implemented or maintained. These tools can make life just that much easier for busy doctors trying to care for sick patients.
Next time you order a tall half-caf soy latte at 120 degrees or a grande quad non-fat one-pump no whip mocha, thank your human barista! She’s doing you a favor by translating into computer speak, and all you need to do is tip her appropriately. And when you order a serum lithiun level yet get a serum lithium result, thank your IT analyst and EHR developer (but tipping those folks is discouraged).
Craig Joseph, MD, is the Chief Medical Officer at Avaap where he works with healthcare leaders to implement and optimize EHRs in order to increase physician satisfaction, improve efficiency, and ensure full value of the technology.