--- "Daniel L. Johnson" <[EMAIL PROTECTED]> wrote: > On Sat, 2005-05-07 at 08:34, Jim Stuttard wrote:
:-) Thank you Daniel for a historical note of what happens when technology preceeds education and, "stupid" people are given responsibility to maintain information that the clinician can make any sense of, and will be expected to make sense of the "stupid" stuff. History will repeat itself no doubt, again and again and.... regards Nandalal > > ... > > The UK Brit Med Assoc (BMA) complained the media > that general practice > > (GP) primary care doctors at ~10 min per > appointment resented the > > displacement of their focus away from the patient > represented by > > concurrent data entry. > > Once upon a time, 20 years ago, I became a (US) > FAA-designated aviation > medical examiner. My nurse and I made little > scribblings on our FAA > form as we worked. A healthy pilot took about 20 > minutes of her time > and about 20 of mine; when we were done the > secretary typed up our notes > and the certificate nice and pretty, and the airman > trudged off armed > for duty. > > Then the FAA, to reduce their own paperwork burden, > created a database. > The doctor or the secretary now typed *all* the > information on the form > into an DOS data entry screen. By *all* I mean that > the airman's > responses had to by typed in as well. In order to > get the airman's > certificate out the door in the same time as before, > I > (a) bought a laptop computer > (b) brought it into the exam room > (c) typed his responses myself while interviewing > him > (d) typed my findings after examining him > (e) printed the certficate by mounting it on a > template and feeding > this through my printer. > (f) twice a month, I plugged in a modem and batched > all the exams to > the FAA database. > > Benefits: > The airman had his ticket the moment we were done: > no waiting for > secretaries. > The software knew the certification rules, so I > didn't make stupid > mistakes or leave out details. > > Drawbacks: > It took 10 more minutes of my own time in the > office. > (Yes, I tried having the airman enter his own data, > but repairing the > damage took more time than doing it myself. And > some of these pilots > are too stupid to understand how to fill out the > paper form, never mind > the computer. Don't get me started...) > > It came to pass that the internet became a tool, and > so the FAA decided > to make this more efficient by having an on-line > data entry tool, so > that the information would be immediately captured > by their database. > The AME was now required to have an internet > connection and a browser. > > I will spare you the details; this new software was > not well engineered, > and the FAA purchased inadequate bandwidth. The > error-checking > vanished, one had to wade through 8 successive > data-entry pages, and (it > being a browser) could not print a properly > formatted certificate when > done. Back to the secretary. > > With all these advances, it now took an additional > 10 minutes of my time > to complete a physical for an airman with no medical > issues. And > meanwhile, computers and word processors flourished, > and the secretaries > have no typewriters, and the one remaining > typewriter in our > institution, a fine old IBM Wheelwriter, was > bequeathed to me by our > administrative secretary, who said, "I'll come get > if if I need it." > > The next advance in this system is to have the > airman provide his data > at home via the internet, directly entering his > medical history via an > encrypted page. Never mind that half the airman > need hand-holding and > coaching to get the blanks filled in with the > information that actually > belongs there. > > The airman will then be provided a pass code to take > to his flight > surgeon (that's me). We will pray that he writes it > down; that he > remembers where he put the note; that he brings it > with him. Then, when > we have finally obtained the forgotten pass code by > telephoning the > support specialists in Oklahoma City, we will have > to review his data > and separately document correction of all his errors > (rather than > coaching him to do it right the first time). > > Yes, the efficiencies of IT EHR are indeed > wonderful. In this case, the > efficiencies are all in the FAA offices. > > But I'm not complaining. It's fun and entertaining, > as these are mostly > healthy folk and there's no pressure to do miracles. > > Dan Johnson md > > __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com
