The following is for SFGH specifically. As a family medicine resident, I am in the unique position of acting as an OB gyn, pediatrics, emergency medicine, and, of course, family medicine resident. Because of this I am exposed to learning various different electronic medical records which do not always talk to each other that well(LCR, ECW, watchchild, pulsecheck). Each department uses the system in a different way - pediatrics uses ECW and sometimes LCR, the ob department uses watchchild and LCR. watchchild does not communicate with the outside world, and thus much time is wasted trying to track down birthing information which has been inputted into the computer. there is also a redundant system where a birth note has to be hand written as well a separate electronic birth note has to be written as well. Tell me, in what sane world does that make sense?

Substantial amount of time is spent at the beginning of each rotation getting oriented to a very counter intuitive system (watch child). We also do not use each system to its full potential, still using various amount of paper to maintain our records. In our family medicine inpatient service, we write our history and physicals by hand still. we don't have easy access to information after the patient is discharged, and much work gets duplicated with each admission.

my proposals are the following:

1. eventual integrated use of EHRs (ONE system) which we all use so that each department can communicate with one another effectively: the most striking example is the admitting team writing orders for a patient in the ED, which then gets printed, which then has to be transferred physically to the nurse taking care of the patient. Having been on both sides of the pulsecheck ED EHR, I see the ease of use of it but yet it does not effectively communicate information for posterity. If you have any doubt of this claim I challenge you to look at a note of a recently discharged/admitted patient and tell me in less than 5 minutes precisely what was done in the ED.

2. eliminating paper! Why are we doing H+Ps on paper? this is the 21st century, and SFGH has the privilege of being situated in the technology capitol of the world. Surely we can figure out how to make all of our communications throught the EHR so we do not have to waste our time tracking down charts which are never where they are supposed to be and read consultants notes that are impossible to read most of the time anyway. See my point above about double charting with OB L+D service.

I love this hospital, the mission it serves, and the patient population. But PLEASE empower the residents to make real change in this place.