EMR and the Falling Patient

The Doctor, by Sir Luke Fildes (1891)

The Doctor, by Sir Luke Fildes (1891)

Is Mom at risk of falling?

Electronic medical records (EMR) efficiently capture physician’s keystrokes—yes or no—to this question and tuck it along side other data about our so–called medical lives. The physician’s judgment has to take into account many factors: is the patient elderly and ‘frail,’ do they have an orthopedic or neurological problem causing them to lose their balance, can they get up from a chair without having to use their arms to push-off, importantly do they live alone. Most of the answers to these questions come quickly through discussions with the patient or their family, or by simply observation. Nine times out of ten physicians can predict that a patient will fall before it happens.

Now, the EMR owns this critical piece of information. But the next most obvious question, as many of you can guess, seems clear: now what? Ideally by clicking yes, a sequence of events occurs; (a) Home health receives an electronic message requesting a patient safety visit. Specially trained home health nurses look for loose rugs that may slip out from under the patient, extension cords waiting to snag an unsuspecting foot, toilets without support for getting up and down, or the need for an electronic alert system bringing help quickly (b) An alert goes to the patient’s pharmacy requesting a drug–drug interaction report, detailing which drugs interfere with each other causing precarious side effects. Alerts also goes to the primary physician highlighting which of the patient’s medication tend to cause problems in the elderly (c) Schedules an appointment with physical therapy for balance and strengthening exercises (d) Arranges for a visual examination and hearing test, after checking on previous tests. These steps become placed into motion within a nanosecond after clicking ‘yes.’

Or does the electronic system just create a list of all patients—that is if anyone thinks of querying the system—whose physician clicked yes to that question? This is critically important and goes to the heart of the promise of new technology. The government suggests that EMR systems are the end all to solving our health care inefficiencies and exorbitant costs. But as we have just learned, the power is not having the data—its knowing what to do with the data we have. Moving information to action. If we can almost predict that a patient is going to fall, without using anything other that our eyes and ears, what physicians need is help quickly arranging for solutions to prevent a fall from occurring in the first place. Any respectable Accountable Care Organization, relying on EMRs to revolutionize patient care, has to have this seemingly basic ability in place now. Otherwise, we just have patient data collecting dust and we can do better than that.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

2 Responses to “EMR and the Falling Patient”

  1. I would suggest you crusade for the information in your July 4, 2010 post called “We All Fall Down”. I really felt this was a positive step if the system first alerted the patient, then the families and friends, then the health care givers from the bottom up about certain warning signals. The depth of the notification would depend on the severity of the instability. No need to start a “flash” response to all concerned unless the lower levels can not provide the necessary care. Keep up the good work.

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