software: how electronic medical records could be better

On an Ars Technica story on AI in hospitals, “goofazoid” commented

There are so many things that have set this environment up, mostly having to do with hospitals attempting to save money (nursing is usually the largest expense in a budget) by having fewer nurses. This has been compounded by data systems (like CHCS/Alta, Meditech) that are not user friendly and take longer to document in than a paper record would, while having lower fidelity than a paper record would.
I think that every nursing unit should probably have at least 2 more nurses/shift, and if you want really good documentation… switch to a tablet type device that can do many time saving things:
-use a smartcard and pin to log in
-use the camera to scan the pt armband so that you don’t have to search for your pt’s records
-use the camera to scan medication bar codes to document
-use the camera to scan blood products bar codes for safety and documentation (either two nurses with two different devices would scan to complete the documentation or the second nurse could scan their badge and type a pin)
-sync vital signs from the device measuring them to the chart
-gives lab results as soon as they are available, and uses the minimum number of alerts to minimize alarm fatigue
-uses the NFC to do things like program IV pumps (directly from the orders), collect amount infused, etc
-has a low power laser range finder to be used in conjunction with the camera to take pictures of wounds, dressings, drainage etc. (the range finder allows a 1x1mm grid to be accurately superimposed on the image)
-has the ability for nurses to use a BT headset to dictate notes rather than typing
on top of all of that, there needs to be a requirement that physicians use a system that is similar- NO F***ING PAPER! If orders are written on paper they must be transcribed and errors can then occur; same goes for phone orders. There is no reason that the MD/NP can’t put the orders in from a handheld device, even when offsite.
-have it set up so that if there is a lab out of range, it messages the provider who can then enter an order (triggering an alert for the nurse)
-have it set up so that nurses can text providers about issues that need addressed less than urgently
-allow diagnostic images to be viewed (EKG, x-ray, CT scan, MRI, Echo-cardiograms, sonograms etc)
The whole concept is to make the system user friendly, interconnected and safe…

My response:

Why aren’t Electronic Medical Records companies throwing money and resources at you to make all this happen?!!!

I recently read the great Atul Gowande’s Why Doctors Hate their Computers and it is so depressing how far these systems are from helping doctors do a better job: zillions of automatic alerts that everyone ignores, people Select all – Copy – Paste entire reports into fields instead of writing a summary, the choice to spend precious time with a patient staring at a screen or to spend hours at home doing data entry, … (He concedes the systems are benefiting patients who review their records.)

Here’s my idea. instead of every data entry field being a chore it should be a just-in-time avenue for understanding. If it’s a multiple choice, every previous entry in that field should be shown in a cloud showing the history and most common ones for this patient; if it’s a number, show a sparkline graph of previous readings that highlights diversions from typical results. Etc. It’s stupid to rely on doctors reviewing previous records, instead in real-time the systems should be showing trends and alerting non-standard data as people enter it.

And obviously, blockchain!

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