DOCtalk by Dr. Gregg 11/4/13

The Nightmare After Halloween

My youngest son wanted to watch Tim Burton’s oddball Halloween/Christmas animated movie “The Nightmare Before Christmas” on Halloween night. We did. Little did I know it would the harbinger of dreadful things to follow.

I awoke the following day, sipped coffee, caught up on email (again learning that Barrister J. Tongai had $20 million ready to send to me for safekeeping), and readied for what seemed like any other day at the office. I should have heard the ominous music begin to swell on my life’s soundtrack.

When I arrived at the office, everything looked normal enough. The staff’s good morning greeting sounded routine and pleasant. The lights were on and the cichlids were silently swimming in our waiting area aquarium.

However, when I rounded the corner into our main work zone, I stopped dead in my tracks. Everywhere I looked I saw piles of paper! Charts and chart notes, faxes and physical forms, school notes and sticky notes, letters and legal papers – all strewn about in some monstrous organizational pattern which I had long ago forgotten.

I’m not ashamed to say I shrieked, just a little.

My office manager, Maggie, looked up and asked, “You OK?” I silently trembled, minimally shaking my head. “What’s wrong?” she again queried me. Still dumbstruck, I felt myself fall back a half step, almost losing my balance before catching myself by grabbing a counter.

The rest of the staff now noticed and turned to see what was up, still acting as if nothing was amiss. The horrified look on my face must have been evidence enough, for they all said, almost as if scripted and in near harmony, “What’s the matter?”

I shook my head again, quickly, trying to stir some words from my throat. I let out only a small whimper at first, but was able to find my tongue shortly thereafter. “What the hell is going on here?” I asked with more of a plea to my voice than I intended.

“What do you mean,” asked Kim, my salt-of-the-earth nurse.

“Where on God’s green earth did all this paper come from? Where did those charts come from? Why is this place such a chaos of wood pulp?” The questions rolled out in a near singular sentence.

The staff all looked at each other with eyes that bespoke their befuddlement (and possible curiosity about my sanity.) “What do you mean?” questioned Kim yet again. “We thought we had cleared through a lot of the stacks from yesterday. This looks good compared to how it looked an hour ago.”

I could feel my knees begin to buckle. I looked about. All I could see were piles upon piles. There were lab results in piles, consultant notes in piles, radiology readings in piles, patient phone call messages in piles, prescription requests in piles, unsorted faxes in piles, charts upon charts in piles. Piles and piles of paper, everywhere.

Then I noticed: no computers! The desktops were gone. The laptops were gone. The tablets were gone. The high end scanner was gone. The insurance card scanner was gone. The credit card scanner was gone. The patient touchscreen registration portals were gone. No digital anything anywhere my eye could see, save the fax which was busy spewing forth ever more paper.

It took only a moment before the full weight and meaning of this fell upon me like a load of wet cement: I had lost virtually all connectivity! (Except for the fax machine, though it’s paper and ink consumption only served to deepen the impact of the moment.) My lab interface was gone. My immunization registry connection was gone. Our online scheduling was gone. Our secure patient email was gone. Our barcode scanning and supply chain management was gone. Our digital referral capacity was gone. Our website was gone. Our HIE interface was gone. OUR EMR WAS GONE!

“NOOOOO!!!” I screamed in absolute horror. “This can’t be happening! What’s going on here? This is unthinkable! No. No. No…”

Maggie arose and grabbed me by the arm, leading me to a chair. She sat me down and said, “Dr. A., you seem a little more off today than normal. Why don’t you take a minute to sit and maybe take a few deep breaths? You just sit there and we’ll bring you a cup of coffee. Barb, get Dr. A. a coffee,” she directed. “I’ll grab your stack of charts from yesterday so you can finish them up while you compose yourself.”

She reached over and lifted a stack of twenty some charts about a foot and a half tall from the morass of chart piles. As she turned to carry them over to me I jumped from the chair and ran screaming bloody murder toward the door. I didn’t see the PDR sitting on the floor before my foot found it and sent my head into the wall.

When I awoke, I was snuggled in my bed with my smart phone alarm just beginning to buzz.

Rubbing the sleep from my eyes, I made a promise to myself to never, ever again watch The Nightmare Before Christmas, son or no son.

From the trenches…

“I am the shadow on the moon at night. Filling your dreams to the brim with fright.” – Oogie Boogie in The Nightmare Before Christmas

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).