Paperless

Stephanie,

I think your story is common.  I have a similar monitor in our lab, but our system has few alternatives.  Indeed, our system has no other electronic alerts.  Many of the techs still use paper pending reports.

It's easy to think of paper and an IS as essentially the same – after all, the computer is designed using a "paper paradigm" – but they are profoundly different.

A pending monitor seems to do what paper does.  Thus, when it "fails" we revert to paper.

This design flaw disables our ability to even think of creating a new process.

But suppose, for example, your IS could make intelligent decisions about what tests to prioritize and whom to notify (by handheld or beeper) when a delay happens.  Software design often doesn't even suggest that such a solution is possible, so most people think paper is still the "standard."

By the way, the Texas hospital and my current employer use the same LIS (Meditech); in TX, all cardiac profiles were ordered as "URGENT" rather than "routine".  Maybe that's a change that the Danville hospital ought to consider...

Our laboratory staff received this e-mail yesterday from the chemistry technical specialist:

"Most of us have been primarily using the big monitor for a pending log and that works well.  Since the intent of the monitor is to not miss ER and other STAT/urgent tests, we typically set it to include only those tests.  One thing that is not included, therefore, is routine tests.

Recently, we have had routine tests such as cardiac profiles to be missed for 24-48 hours, and that is not good.  Using the monitor for routines doesn't make sense because it becomes too busy and hard to manage.

Please pull at least one (PAPER) pending log that includes all tests on your shift.  After checking, initial and put it in the tray like usual.  That should help a lot."

I would be absolutely amazed and astonished if this hospital's lab went as "paperless" as the one in which I worked in Texas any time before I reach retirement age.  The TX lab had "big monitors" in both hematology and chemistry AND always had them set to show all tests.  Some of my older colleagues here in Danville get too "confused" by hematology specimens including pathologist review and chemistry specimens including "send-out" tests making the pending log look too "busy" even if STAT and URGENT tests jump out at one's eyes in YELLOW instead of RED (as in routine) type, I guess. :P

Laverne,

I'm terribly sorry your comment was deleted.  But here it is, since I saved it while writing a reply:

What about the "keep a hard copy of hand-entered results" required by CAP regs and some states? Would love to put a stop to this insanity of paperchasing. How an it be accomplished with these ridiculous obstacles? Please comment further.

I found this online:

"For data transmitted by computer interface (on-line system), it is not necessary to retain paper worksheets, print-outs, etc., so long as the computer retains the data for at least two years.  Manual entry of patient result data requires that all worksheets, print-outs, etc. are retained by the laboratory for at least two years."

http://www.cap.org/apps/docs/laboratory_accreditation/checklists/laboratory_general_april2006_changes.doc

I think the goal is to eliminate worksheets.

The solution may be to bring IT to the location of the test, thus eliminating the need for the worksheet.  If a terminal isn't nearby, this can be done by using a thin client laptop or handheld device.  Nursing has mobile POC entry – why not the lab?

Bottom line: if it isn't easier than writing it down on paper, it won't get done.

Sure, however;

                         I dread going back to paper slips, can't read the chicken stratch and often they are gone with the winds of ventilation.  And for the few hours that the system was down, the printer stopped killing trees, but we noticed all those infernal paper pushers had moved on to other parts.  Sure chould'a used 'em.  Partner, Ya need better systems, hardware, software, interfaces, the whole shoot'n match.  Also folks with a mind to use em right might be real dandy too. Can't step in the same river twice. Nope, can't!  Gota push on, hope'n that Obama fella comes with the posse to help us out.