Wednesday, May 07, 2008

Bacertial Rasmosis

In the coming age of the electronic medical record, all of your health information will be stored as pixels and megabytes. The consequences of this are far-reaching. Hopefully, your record will be able to move seamlessly between doctors and accessible no matter which ER you find yourself in after one of your drunken tree-climbing escapades. Of course, EMRs are not yet standardized, what with 5 or 6 competing software companies hawking their services. And there is the Health Insurance Portability and Accountability Act (HIPAA) to deal with... (What we really need is a Health Information Portability and Accessibility Act!) But this is all to set the stage for a unique problem faced in health care.

How does all the information get into the computer?

Doctors from my generation (and especially my 5 year younger classmates) grew up typing. They'll be able to type their notes and orders real time. In the outpatient setting, many resident physicians carry a laptop into the office to enter patients' data. But what about the folks who can't type very fast?


Doctors have notoriously bad handwriting. As patient encounters became more important for the legal record and later were stored digitally, there needed a way for scribbles to be translated into typeface. Docs started using services that would transcribe speech into text. Sometimes 'in house' stenographers collect tapes at the end of the day and type them up the next day. In more urgent situations, docs can call an 800 number and connect with a service that contracts out the conversion from spoken to written word.

These days, voice recognition software is phasing out the transcriptionist. Voice recognition is good enough that docs can list the illness history, physical exam findings and treatment plans realtime between patients.

But whether it's human transcription or computer, there will be typos. Take for example my recent discovery of a patient who presented with a significant history of bacertial rasmosis. 'Bacertial' looks enough like 'bacterial' that my mind barely noticed it. But rasmosis? A new class of infection? I immediately consulted Dr. Google. About the closest I could find was the species name for the herbal called black cohosh. Cimicifuga racemosa. Black cohosh is bad enough for you - especially in women of child-bearing age. I hadn't heard of infection exacerbation. That's the funny thing about medicine - there's always something new to learn.

The other funny thing about medicine is that some of what you learn is wrong.

Enter the punchline. This woman had recurrent bacterial vaginosis. The record was an error of transcription. Welcome to the EMR.

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