From a psychiatrist, partially in response to the article about me in Kaiser Health News, on the travails of health IT.

They write:
... In psychiatry we screen for certain medication side effects using a tool called "DISCUS."  [Dyskinesia Identification System Condensed User Scale - ed.] In a paper and pen world, we (1) reviewed a single page; (2) circled a score; (3) signed and (4) dated.

In [redacted] EHR, we need to do the following to complete one DISCUS…
    
DISCUS Completion in [redacted] EHR:
  • 1.  Log in;
  • 2.  Acknowledge to do items by choosing “ok”;
  • 3.  Go to “my to do list.”
Then:
  • 4.  Double click specific date of to do items to complete (this reveals the specific to do items)
  • 5.  Right click specific patient’s name
  • 6.  Choose “enter option”
  • 7.  Review all 3 pages under “assessment” tab (click through each page)
  • 8.  Then choose “evaluation” tab
  • 9.  Review “evaluation” (keeping in mind the total score from last page of “assessment”)
  • 10.  Choose your “conclusion” in item 5
  • 11.  Add “comments” as indicated (item 6)
  • 12.  Under “name/ID number” type in the first characters of your last name (or your ID number)
  • 13.  Select your name
  • 14.  Go to the bottom under “select physician to notify” and UNcheck your name
  • 15.  Click “yes” under “is evaluation section complete and ready to be locked?”
  • 16.  Confirm above choice by choosing “ok”
  • 17.  Press “submit” button across the top
  • 18.  Now go back to “my to do list” and you’ll see that the item you just processed above is still there -- double click the same to do item that you just finalized (and processed in item 5 above)
  • 19.  Then check “reviewed”
  • 20.  Then press “submit”
  • 21.  Then press “refresh” and the item will be completed (refresh does not need to be done after each DISCUS)
Finally:
  • 22.  For processing of additional DISCUS for a given “sign on," go back to step 3, 4 or 5 (as needed), and repeat.

And this is just the easy stuff.

I'm not a psychiatrist, but I can opine with confidence that anyone who expects human-computer interaction such as this to "revolutionize medicine" is insane.

Perhaps this helps explain city-wide debacles such as this in San Francisco.

-- SS

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