An ongoing dialogue on HIV/AIDS, infectious diseases,
February 24th, 2013
Solve This Problem Please — Microbiology Results in Electronic Medical Records
(Weirdly — and I kid you not on this — a version of the first iteration from the 1980s is still around, running parallel to a more modern program. That old one remains the best at displaying simple things, like quickly showing a patient’s creatinine or white blood cell count.)
But one thing all these EMRs have in common is that they are pretty lousy at rapidly displaying microbiology results. I certainly see the problem — microbiology reports are a melange of obscure words, diverse numbers, and inscrutable abbreviations. And finding important results in a complex patient with dozens (or hundreds or thousands) of cultures is a major challenge for even the most tech-savvy clinician.
With current EMRs, it’s as if all the work that went into designing text macros and special “functionality” (cringe) had thoroughly drained the programmers’ brainpower, so by the time they got to the microbiology part they just gave up. I can just imagine a dialogue between team members as they faced writing the software for microbiology, realizing that there might be more to an EMR than just fast ways to spit out boilerplate text and nifty graphs:
Software Engineer 1: Hey, look at this — the clinician can now enter a complete normal physical examination just by typing “alt-PE”. And if they hit “control-alt-F7”, then it inserts three paragraphs that document a review of systems, patient education/counseling, and plans for follow-up — a guaranteed billing up-code.
Software Engineer 2: Cool! And watch this — we can graph this patient’s MCV, MCH, and MCHC going back to 1983 in 3 dimensions and using 9 colors. Nifty MP3 audio file adds a “swoosh” sound when the graphic appears.
Software Engineer 1: Awesome, great work! (Takes a swig of Red Bull, eats a few Doritos.) Hey, did you decide what to do with this information? (Hands over a piece of paper with the following printed on it.)
Specimen: Wound Date collected: February 16, 2013 Date reported: February 18, 2013 4+ PROTEUS VULGARIS GROUP VITEK AST-GN53 CARDAntibiotic Result ---------------------------------------------- Amikacin <=2 S Ampicillin >=32 R Cefazolin >=64 R Cefepime <=1 S Cefoxitin <=4 S Ceftazidime <=1 S Ceftriaxone <=1 S Ciprofloxacin <=0.25 S Ertapenem <=0.5 S Gentamicin <=1 S Levofloxacin <=0.12 S Meropenem <=0.25 S Nitrofurantoin 128 R Trimethoprim/Sulfamethoxazole <=20 S Unasyn 8 S 4+ ESCHERICHIA COLI VITEK AST-GN53 CARD Antibiotic Result ---------------------------------------------- Amikacin <=2 S Ampicillin <=2 S Cefepime <=1 S Cefoxitin <=4 S Ceftazidime <=1 S Ceftriaxone <=1 S Ciprofloxacin <=0.25 S Ertapenem <=0.5 S Gentamicin >=16 R Imipenem <=1 S Levofloxacin <=0.12 S Meropenem <=0.25 S Nitrofurantoin <=16 S Tigecycline <=0.5 S Trimethoprim/Sulfamethoxazole >=320 R Unasyn <=2 S
Software Engineer 2: (Wearily.) Nah … too tired. (Drinks some Mountain Dew. Gets excited again.) I know, let’s work on building in even more ways to guarantee that people will forget their username and password!
Maybe I’m not being fair to our friends in IT, but it seems someone should have figured out by now how to make information from the microbiology laboratory more digestible — maybe even searchable! And as our institution is in the midst of a giant shift — one could even call it an EPIC shift — to a new EMR, I’m hopeful we’ll see some innovative work in this tricky area.
Any bright ideas out there?