Wednesday, April 04, 2007

Drug recall

We had a drug recall this week, for Zelnorm , a drug used for constipation in irritable bowel syndrome. Zelnorm was linked to an increased risk of heart attacks and strokes.

When I received the fax from the manufacturer, I ran a search for all patients on this drug. I also know how to put in alerts, and generate a mail-out. This wasn't difficult to do, as I've done it several times for preventive services. I sent out a "how to" email to my FHN colleagues, and also posted it on my on-line discussion group.

Zelnorm is not a drug used for many patients in family practice. It was good that the first drug recall with the EMR was small and manageable. I can see that the process works; it will work for a large recall, such as Vioxx, but the number of letters will be considerable. We should be be figuring out the role of the big pharmaceutical companies, they really should bear the costs of this targeted notification if one of their products is at fault. It may be time for our political organizations to get involved, ahead of time; this is certainly not the last time there will be a drug recall.

I found out that my application is part of the hospital's network, since the server is inside the hospital. This is interesting; I tried accessing my office from one the PCs in the doctor's lounge, which works. I think this is potentially very useful for members of my group who do OB, in-patient care or palliative care; they can access the EMR from any computer in the hospital.

On another note, I had an interesting discussion with a colleague on what exactly is meant by the EMR "dashboard", which is really a question about how information is presented. I think as a dashboard as an overall view of the information (like a car's dash). There are different ways of presenting that (and not one size will fit all).

I figure that there is a trade-off between a simple dashboard, which will be easy to learn, and a complex dash, which is more useful later on, but is harder to learn. Good programming will present the dash in a way that will shorten the learning curve, while preserving some complexity. A car is an example of a fairly intuitive dash, with some complexity; the fact that it is so prevalent in our society has made good engineering ubiquitous. You have a very short learning curve when buying or renting a new car, because of the similarities in dashboard construction. When you need more complexity, example, commercial airplane, the amount of training increases. Once you have used the dashboard for a while, the amount of unconscious processing increases dramatically; I can take in a lot when I look at the front page in my EMR, but this didn't happen at the beginning.

The Dashboard for individual patients, rather than practice level, would follow similar guidelines (simplicity vs learning curve; choosing the most important info to present, not too much, not too little; navigation issues). It is an interesting interface between the computer and human psychology; a Steve Jobs should get involved in EMRs--his elegance and flair for design would help.


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