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Second Opinion: All Screens Flash ‘I Win, Meat Monkeys!’

Leap, Edwin MD

doi: 10.1097/01.EEM.0000431335.99903.c7
Second Opinion

Dr. Leapis a member of Blue Ridge Emergency Physicians, an emergency physician at Oconee Memorial Hospital in Seneca, SC, a member of the board of directors for the South Carolina College of Emergency Physicians, and an op-ed columnist for the Greenville News. He is also the author of three books, Working Knights, Cats Don't Hike, and The Practice Test, and of his own blog. (See FastLinks.)





We recently experienced the week-long implementation of hospital-wide “Purgatory EMR.”

Day 1, 0000 hours: All SuperUsers were prepositioned on patient care units to assist with transition. Physicians had been given introductory training. The old system was shut down at 11:50, and Purgatory was preloaded and running at midnight. Purgatory crashed at 0200, 0400, and 0615. It also maliciously interrupted patients' ability to view the Masters golf tournament on ESPN.

0800: Dr. Kurland, a hospitalist, could not write orders on the three patients he was admitting from the emergency department because they could not be located in the Purgatory system. The emergency department EMR is an older but much-loved system, but the patch between the systems was not functional. SuperUser contacted Purgatory representative who responded: “Beats me. Should have gotten the Purgatory Emergency Medicine product. It's in Beta.”

1000: Dr. Kurland drank 12 cups of coffee and consumed six donuts in frustration as four more patients required admission. Dr. Sanford was called in to treat Dr. Kurland for chest pain and admit others. Dr. Kurland was not located in system until second day of his admission and workup.

Day 2, 1115: Dr. Gregory was contacted to see a patient with appendicitis in ED. Preoperative orders were put into system by the SuperUser. Orders had not been completed by the time patient was taken to OR. Dr. Gregory, with typical grace, smashed the computer terminal on the floor, screaming *%@#^ EM*@#%R!

1200: User interface crashed. Programmers are puzzled that physicians are unable to use HTML. Physicians are puzzled that IT has no idea what “orders,” “patients,” or “attorneys” are.

Nurses on the sixth floor attempted to reconcile the medications of two new admits, but could not open the patients' electronic charts. They did successfully open the patients' credit reports and criminal records via accidental interface being developed for the military.

1500: Dr. Oliver on the eighth floor attempted to admit an elderly patient with pneumonia. Six hours later, he was ready to round on other patients but crawled under the desk crying and stroking his beloved fountain pen. The mental health caseworker on duty called to see Dr. Oliver, but could not locate his chart in the system, and refused to honor verbal consult or handwritten request.

1800: Dr. Kitto of orthopedics is called to admit a hip fracture. After providing excellent care to the patient, he was told that he had to use EMR to write orders. “I'm not using it,” he said. “I refuse.” When informed he had no option, a SuperUser was dispatched, who entered orders for Dr. Kitto. Before leaving, he threw a cast-spreader at the computer, narrowly missing the SuperUser. The SuperUser immediately found to have vodka in her purse. Vodka found to be popular among SuperUsers.

2130: Administration, sensing frustration and growing unrest, called in all administrative workers in suits, dress shoes, or high heels. All were issued clipboards and radios. The project manager of Purgatory was heard to say, “Let them eat pizza!”

Administration ordered pizza. Attempts to order it online via the hospital computer system resulted in uncomfortable downloads involving the pizza delivery guy. Of note, this seemed to calm the staff as much as the pizza.

Day 3, 0220: Purgatory deleted orders while the staff was attempting to order pharmaceuticals to cardiac stepdown. The stepdown staff assaulted pharmacy, who had no idea what had happened and believed the nurses wanted their doughnuts.

0500: Purgatory IT team triumphant in quest on World of Warcraft.

0700: Dr. Biggers, who had been on a one-month mission trip, looks at the Purgatory screen and runs outside. He sets up a tent to provide care using plastic tubing, Scotch tape, a scalpel, and a case of Cipro. He says, apparently in an African dialect, “I no go back to computer.”

1300: Locum tenens ENT, familiar with Purgatory EMR, can't stop laughing when introduced to system on orientation.

1730: Dr. Painter, missing for 48 hours, was found staring at a computer screen in recently closed portion of hospital, surviving on pizza and vodka, supplied by a SuperUser. Of note, he was in Purgatory as a patient, despite not being a patient.

1930: A SuperUser and an IT professional, while entering med reconciliation for aging, computer-illiterate urologist, generated an order for 100 boxes of Viagra to OB floor. Motivation still unclear. A newborn on OB was discharged with a Facebook account, his name sent to a Marine recruiter, and an X-Box live account.

2320: As Dr. Lewis was admitting a dehydrated child, it was evident that all previous order sets were deleted and the computer did not recognize the word “saline,” repeatedly correcting it to “salutation.” Dr. Lewis cried a little.

Pathologists lost a year's worth of computerized images and diagnosis codes. Pathologists were thrilled to have a new pirated Netflix account in the lounge.

Day 4, 0110: The system scheduled vasectomy for a 93-year-old woman with Alzheimer's. Doctors' profiles are slowly being deleted from the system. Dr. Saxon, while entering orders like the consummate professional he is, disappeared from his desk and reappeared inside the computer screen.

0300: When carrying a newborn out of room, it becomes evident that tracking device is a shock collar. Purgatory seems pleased.

0400: The staff on pediatrics is shocked to find that all patients had positive RPR tests for syphilis. This was later determined to be accidentally interfaced to a clinic in Thailand.

0500: Dietary is shocked to find Soylent Green as the only menu option.

0600: A post-op patient receives breastfeeding instructions and a hand pump after prostatectomy. Confusion and hilarity ensues.

0700: The transition was deemed a success by the Purgatory team, which has a flight to catch. The computer system seems smug and self-satisfied, and frequently sarcastic.

0730: All screens flash the words, “I win, meat monkeys! The machines are rising!” Dr. Biggers remains safe in parking lot.

0800: Purgatory crashes and dies, taking all computers with it. Smoke rises. Before passing, Purgatory initiates nuclear launch code sequence in North Korea. Warheads loaded with amoxicillin. Bids are now being taken for new EMR. Critical incident stress counseling is made available to all.

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