Unplugged from the EMR: Now what?

By Suzanne Berman, MD

The surgical metaphor often used for home improvement is “a face lift,” but our thirty-year-old house needs a quadruple bypass and liver transplant. Because it’s going to be so dusty and disrupted, we opted to temporarily move out. Two weeks ago we moved to a quiet rental house in the country, where we can watch fabulous Tennessee mountain sunsets and wake up to the sound of cardinals singing.

The price of solitude is something of a challenge: no cell phone service at our home. Neither my husband’s AT&T phone nor my Verizon service gets any solid bars at our new house. We’ve arranged to get Internet service, but the cable guys haven’t come out to our home yet. We’re not quite 19th century, though, as we have a functional land line.

So last Saturday, on call, I had just returned from a morning at the office to my home (now a 25 minute commute rather than a 10 minute one) when I received a call (land line, of course) through our answering service. A mother apologetically confessed that her daughter was about to leave for summer camp but had just run out of her routine medication. Would it be possible for me to call in a refill?

“No problem,” I said. Although I almost always decline to call in new medications over the phone, refills for established medications are different.

This young lady was well known to me, as she’s been my patient for about 8 years now. Her medical issues are familiar to me without having to look at her chart, and her problems are well-controlled on her current medication. Indeed, I didn’t want her going out to camp without her prescription. After confirming the pharmacy with mother, she thanked me, and I hung up.

…And about two seconds later, I realized I wasn’t sure of the dose of the medication. This particular medication is often used in both 20 mg and 40 mg preparations, and while either dose would probably work for this young lady, I wanted to be sure to refill her usual dose.

Now I had on my hands, for me, a relatively unusual problem. My lifelong geek tendencies made me an early adopter of an electronic medical record (EMR). I can log in securely from home over the Internet, call up the child’s chart, and double-check the dose myself. But stuck at home without Internet service, I was clearly going to have to find a creative solution to this problem.

Maybe I can call the mom back. Unfortunately, I didn’t ask for her number while I had her on the phone. My caller ID read our answering service’s number, not the mother’s;

unfortunately our answering service doesn’t record the number of callers unless they have trouble reaching the physician quickly.

Well, I’ll call the pharmacy. They’ll have her previous prescriptions and can confirm the 20 mg vs. 40 mg question. Clearly, I should have thought of that initially. “No problem,” I muttered aloud, while wishing that the cable guy had come last week as expected.

And I realized I didn’t have the number for the pharmacy, a chain drugstore in a neighboring county. Our phone books were still buried in some packing box. Aha, I can look it up on the Intern…..uhhhh, no I can’t.

I considered getting in the car and driving to the office. 50 minutes just to get a phone number? No, surely I could find another way.

I started calling my co-workers, who have the same ability to look up charts from home as I do. Maybe I could cadge a favor from them. No answer at one number. Oops, don’t have the current number for colleague #2. The third answered her cell phone, but alas, she was in the grocery store shopping with two small children. And frozen food. Could she call me back in, say, an hour?

Hey, I can do this! Call the local branch of the pharmacy! They could give me the number to the other pharmacy. Or I could even give them the prescription, and they could send it to the branch pharmacy! Woohoo!

The pharmacy tech couldn’t enter the prescription for me because I didn’t have the patient’s date of birth handy (!), and “it would take three hours to send it to the other pharmacy” (when it takes me thirty seconds to send it electronically from my office to either pharmacy?). I did, however, get the number for the other pharmacy.

Which I called — only to get an endlessly looped recording, without the ability to leave a message at the pharmacy. “Press 8 if you are a doctor’s office,” an anthropomorphic impossibility, but I complied. After a few clicks, it looped back to the main menu, “Thank you for calling Quik-Drugz. Press 8 if you are a doctor’s office…”

This poor girl, stuck at camp without her meds! I ended up getting the car with my smartphone and laptop, driving around about 15 minutes until I got a steady two-bars. I pulled over to the side of the road, the spring heat baking through the window, my blinkers flashing, while I fired up my Internet connection…. logged in…. found her chart (aha, only 20 mg, not what I would have guessed)…. and sent the prescription to the pharmacy, yes!

And then got another page. “Dr. Berman,” the answering service explained, “we’ve been trying to reach you for a while…”

Fortunately, the next call was a discussion of high fever in a toddler. We reviewed fluid intake, ibuprofen dosing, and what to watch for – much less complicated than having to call in a refill.

I guess you can take the geek out of Internet range, but you can’t take Internet out of the geek.

Dr. Suzanne Berman is a practicing pediatrician in Tennessee. She recently celebrated 17 years of marriage to fellow geek Robert Berman, MD, who continues to impress her with his Holy Grail quotations.