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The Intensity Of EMR Warnings: Who Do They Really Help?

Discussion in 'Hospital' started by Hadeel Abdelkariem, Apr 24, 2018.

  1. Hadeel Abdelkariem

    Hadeel Abdelkariem Bronze Member

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    Eons ago, there was a television show where a non-human character would yell out, “Warning, warning,” when he sensed imminent danger. The series was called Lost in Space where we were entertained by a set of quirky characters on a cheesy set. We loved that stuff. It’s hard to imagine today’s millennials and younger folks being transfixed, as we were, with the deep television dramas of our day. Who could match the subtle allegory and nuance of shows such as Green Acres or Gomer Pyle? Some superficial viewers regarded The Andy Griffith Show as a homespun, idyllic view of small-town America. In truth, it was a biting satire on the excesses and abuses of law enforcement in the 1960’s.

    I am overwhelmed with the warnings that I receive in my work and in my life. It seems that warnings, caveats, and disclaimers are so omnipresent that they have lost their impact. As I write this, I am seated in McDonald’s, sipping a cold beverage that does not quite qualify as a nutritive elixir. Had I chosen a steaming hot cup of joe, I’m quite certain that the beverage’s container would warn me that it contains a hot beverage. Such a warning, of course, is of great benefit to the consumer, who would behave entirely differently equipped with the knowledge that his hot coffee is actually hot.

    With some regularity, when I prescribe a medication using our office’s beloved electronic medical record (EMR), a red warning flashes indicating that there is a potentially severe interaction with one of the patient’s current medications. The intensity of the warning would suggest that I was prescribing cyanide or rat poison. Our EMR allows me to bypass the warning and prescribe anyway, leaving this action memorialized in the EMR and available to plaintiff attorneys who might be in a position to query me on this decision, should an adverse medical event ensue.

    Now, I take these warnings seriously and would never place a patient at risk, unless the medical circumstances justified it, and the patient was properly informed. My point is that many of these electronic warnings are hyperbolic, if not spurious. Many times when I call a pharmacist — a human drug professional — in the presence of the patient, I am advised that there is no material risk. In fact, the last time I did this just a few weeks ago, the pharmacist assured me that there was no risk of an interaction. I always document these conversations in the record and hope that the truth would set me free, if necessary.

    I cannot explain why the EMR’s software is set so sensitively. I suppose I could investigate raising the threshold for issuing an apocalyptic warning, but then I might miss some actual legitimate warnings.

    Do you think that all of the warnings we read, hear and trip over are issued to protect us or the companies and organizations that issue them?

    Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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