Wednesday, July 04, 2007

Fridge police

On Friday, the Fridge Police came by my office; these are the nice public health nurses who make sure that the fridge temperature is properly monitored, and within range (2 to 8 degrees), that none of the vaccines are out of date, and that vaccines are properly stored (not in the fridge door). It is important to make sure that the cold chain is preserved, so that vaccines are as effective as possible.

I can see why they are needed. However, this almost led to a disaster at my office. I was away at the cottage (no internet access) on Friday; my secretary was left to deal on her own with the unannounced visit. I use a data logger to record temperatures in my fridge. The logger is a little credit-card sized device; it sits inside the fridge and automatically records temperatures every 15 minutes. Once a week, my secretary sticks it in a cradle that is connected to a computer, and the data is downloaded to the PC. It generates both lists of temperatures and graphs; the minimum and maximum range (2 to 8 degrees) is indicated, and I can see that I am always in range. We also have a digital thermometer sitting on top of the fridge, so that the temperature is always visible when I take vaccines out.

The nurses were very upset with the fact that my secretaries were no longer handwriting minimum and maximum temperatures twice a day in a book; they threatened to impound my fridge for five days. My secretary pointed out that what we do far exceeds requirements, and that there is no opportunity to “cheat” (that is, record a false value if the temperature is out of range). She showed the nurses the graph on the computer. The problem was that the nurses had never seen a logger, and were not familiar with that technology. I am very happy to report that they decided to call their manager, who went over what I was doing, and stated that it was acceptable. My secretary got a little paper certificate stating that we’re OK.

This illustrates the issues that early adopters can face, despite the best intentions; you sometimes have to demonstrate and advocate for better workflows using IT. Public Health serves a very important role, but they seem to have particular difficulties with computerization. None of the public health lab reqs are computerizable (virology, HIV, prenatal), and they often involve obscure codes for lab requests. Because the reqs are paper-based, I cannot keep track of whether the result has come in. None of the results are sent electronically; they all have to be scanned in. There is no secure electronic access to public health labs. There seems to be no electronic way to report infectious diseases to public health; this has to be done by phone, slowly and laboriously: you have to spell the patient’s name, and personally give all their demographics. No wonder I cringe when I see a reportable illness; it's not the report, it's the process. Perhaps this could be integrated via the EMR, and sent via the secure SSHA email system, which hardly anyone is using right now. I don't mind emailing a copy of my temperatures on excel; that may lead to a reduction in unnecessary visits to my office to check my fridge.

On another note, I've installed secure access to the EMR on a computer in the doctor's lounge at my hospital, and in the physician's room on the Labour and Delivery floor (several physicians in my group deliver babies). That seems to be working well, but I have found that I can't easily log on from the lounge: doing this can develop an interest cluster of physicians and lots of questions.


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