A Shocking Journey: Health Data Reaches EMR Via Writing On Hand

Nurses have one of the toughest jobs in the world.  As for me, I doubt I could do what they do for 30 minutes, much less an entire shift.

And of course, it doesn’t help that half the hospital world doesn’t appreciate them particularly, especially at salary review time. So please rest assured that the following is not a needless slam on the nursing world.

That being said, what I saw tonight in a Maryland hospital ED was appalling. Either the nurse in question was way, way out of line, or someone in IT should have their head examined.

As is often the case when you’re parenting young children, I end up bringing one of them into the ED now and then. (Being a child is a dangerous lifestyle, especially when you’re a venturesome, intelligent kid!) And tonight was one of those times.

The ED was humming, with patients practically stacked in the hallways awaiting triage.  Not surprisingly, nurses were jumping like the proverbial longtailed cat.  But when my child and I were called back, I was still shocked by what I saw.

When the triage nurse asked my kid to step on the scale, she wrote the result on her hand. Then she measured his height. She recorded that on her palm, as well.  As she took his blood pressure, pulse ox and temperature, she transferred the data from her palm to a yellow sticky, and then into the EMR.

In my view, transferring data via sneakernet — heck, palmnet — is something that should never happen if you want accurate data in your EMR.  So why, for heaven’s sake, hasn’t IT provided overworked nurses like ours with a COW or wall-mounted terminal or tablet they can use to capture data when away from the triage desk?  Otherwise, given the pace at which nurses work, what does CIO think will happen?

While I’m not happy with the way nurse X handled things, I imagine she’s just adapting to an impossible situation. What’s more, I’m betting that her system is no more or less accurate than manual data entry if she’s very careful with what she does.

But ultimately, hospitals simply can’t allow this kind of thing to happen. Imagine the liability it would face if careless data transfer led to a needless error in care?  The very thought makes me cringe.

The moral of the story, as I see it, is that point of care devices are an absolute necessity these days, not a “nice to have” investment. Sure, picking among various options is a trying exercise, and IT leaders may have to try out a few form factors before they find solutions that work. But let’s not kid ourselves: it’s something that has to happen.

What’s the point of investing a year’s revenue in an EMR if your frontline nurses are fudging data entry?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • This is the normal way data is entered at every hospital I have worked. And COWs won’t solve the problem if you need 53 keystrokes to get to the right data entry point, which is the case with Meditech. (39 with Epic.) If you are surprised, then you have no idea how disruptive these systems are to our workflow.

  • Brian,

    Thanks so much for your comments. Of course, point of care devices aren’t worth much if the underlying EMR is a piece of junk. And it’s also a given that clinicians and hospital staffers will be forced to develop workarounds.

    I’m not surprised, really, that people in the ED are forced to do this — People on the floor are just trying to survive. My point is that I”m surprised that people in IT aren’t doing something to make this less likely.

    That being said, given corporate inertia, and the fondness of boards and C-suite execs for Epic and Meditech, I doubt it will change anytime soon. And so it goes…


  • Brian,
    You’re saying that at every hospital you’ve worked at nurses have resorted to writing things on their hands?

    While you describe the ideal (easy access to the EMR at the point of care), why can’t we address other solutions? Maybe direct access to an EHR isn’t the right path initially. Instead of trying to replace writing on your arm with direct entry to the EHR, why not find an interim solution. I’m sure some will hate the idea, but what about a watch or arm band where you can record key elements. Essentially that’s what writing on your hand is, no?

  • Yes, that’s what I’m saying. The ideal would be to enter data easily into the EMR. But because the software is poorly designed, this is not possible.

    I’m so tired of IT people being shocked at our reluctance to embrace cumbersome software that has never been proven to help patients.

    If a care professional thinks writing on his hand is better than using lousy software, he is probably right, and vendors and IT professionals should be asking what they can do to be better.

  • This type of workaround is common everywhere. I’ve seen floor nurses take a sheet of paper with them as they round on their patients, OR nurses writing on the leg of their scrubs, interns and residents writing on their patient lists, and attending physicians dictating and then listening to their own dictation.

    Even when there are terminals at the point of care, they may ignore it. Logging in and out every 3 minutes is too time consuming when one moves from pt room to pt room, a tablet without a table means one-handed data entry, and cows mostly just annoy everyone (if the batteries aren’t dead.)

    Most clinicians just deal with it and soldier on – hospital administrator’s have made it clear they don’t care about the problems, IT doesn’t seem to be able to get it (or are too “professional” to admit they can’t solve the problem), and so expediency becomes the primary concern – over accuracy, timeliness, or anything else. And everyone just shrugs and says “It’s government mandated…”

    Garbage in, garbage out…

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