TECHNOLOGY: When a hospital’s IT system is dangerous to patient care


Interesting. I finally had time to go thru the exit documents that they made her sign before they let her go. Those instructions are ten pages of virtually unreadable “barbara streisand”. Let’s examine what the hospital bureaucrats — no doubt advised by lawyers — wasted paper and toner on.

Under the heading of “just stupid”, this patient doesn’t smoke, virtually never has. (Me either. Ever kiss a smoker? Yuck. And it makes your wee willie shrink up prematurely. For boys and girls. Look it up. That should be enough to get any youngster to quit. Unless the don’t like using. TMI? Hey this is life. Face it. Like the blog title says.) So why are there THREE separate sections of this load of “barbara streisand” about quitting smoking. One section might be a mistake, two an oversight, three is just no one reads the “barbara streisand” pumped out.

Under the heading of “downright dangerous”, are the two pages of medication instructions. (I have yet to exit the hospital with Frau where these are correct. From my memory, EVERY time we’ve left — and we’ve left a lot — there has been at least ONE serious fmpov error.) SO let’s take score of these instructions.

— We have duplicate instructions on insulin. Literally, separated by incorrect insulin instructions. Luckily, DIABETICDOC#3 was clear with her instructions about what she wanted Frau to take. “Regardless of what is in your discharge instructions”. (So obviously the docs know that these instructions are cobbled together “barbara streisand”.) And, give her even more credit, Frau’s discharge was just a rumor when she gave her exit instructions. (You have to like someone who’s on top of their game. You could almost hear her say: “I don’t care what everyone else is doing. My part of the problem is done right.” She should be in charge. Her or the cleaning lady. Both have their act together.)

— In two items, dosages have been changed which MAY or MAY NOT be correct. (If the lesser dosage is right, then where are the RXes for the new form. Since these dosages were NOT given in the hospital, we’re assuming that this is wrong.)

— Two of her important medications have no instructions at all; so in one case we resumed her old regime and in one case we did not. (Maybe that’s right, maybe that’s wrong.)

— The instructions might as well be written in Babylonian cuniform. It has chemical name, followed by another chemical name in parenthesis sometimes, dosage, instruction, start date, the phrase “ordered as”, and the brand name. (Boy that’s as clear as mud.) The start date is always identical. No where does it say “Take it”. (I know that’s “obvious”. But we are dealing with humans here.) And there’s no indication of what doctor ordered what? (Did my cardiologist really order me to take this cardiac drug or is it one of the other docs covering for him? Who gets sued when it’s wrong and kills me?)

The entire ten page document is a virtually unreadable. I have 20/20 corrected vision. And, I know the tricks one can play with fonts and kerning to pack print on a page. There is a mix of fonts, bolding, and compression that make it a mess to try and read. (Didn’t these folks ever hear of “information mapping”?) As “evidence”, I have a the input from a sample of one, Frau. After scribbling her name on the last page, with it being literally the last thing between her and the door, she look at it, said to me “it’s junk. Can you see if there’s anything important in it?” And, that’s an opinion I can agree with.   

How would I improve it?

Well since not everyone getting out of the hospital has 20/20 vision or a Patient Advocate (PiA) to worry about the “barbara streisand”, I’d completely redesign it using the principles of Information Mapping. It’s not a form; it’s a letter. Signed by the principle doctor and nurse.

It should say. “In order to recover, we want you to take” and then a simple list of drug, dose, and time. And, leave the chemical jargon to the pharmacist. If the patient take Nexium, don’t tell them to Esomeprazole Delayed Release.

For each specialty, it should say: “your DIABETICDOC want you to take:”.

Then a section on follow ups. And don’t tell the patient to do the work. “We have taken the liberty to schedule the following appointments. DIABETICDOC on August 31 at 10AM, BLOODDOC on August 13 at 10AM, CARDIODOC on September 15 at 10AM. You, of course, are free to reschedule these as needed.” (Wow, do some value adding work? What a novel idea.)

Print it all in a nice clean 16 point font and we’re good to go.


Information Technology Architecture and Business Process Reengineering are so easy when someone just cares about the results.

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