In her book, The Cancer Olympics, Robin McGee described being diagnosed with stage IIIC colorectal cancer after two years and four doctors. Mistakes made in the EHR were partly responsible for such a serious diagnostic delay.
In Robin’s situation, Dr. One failed to document her immediate family history of colorectal cancer. But if I had seen her using my system, we would have both seen the EHR record simultaneously on the large screen TV. When documenting family history, both Robin and I would both see as the family history is entered into the electronic record. If there is any inaccuracy, she could have me correct it right then and there. If Doctor One had a similar approach, Robin may have noted that her family history was omitted, and if corrected may have altered the workup for a quicker colonoscopy.
Doctor Two, her regular GP, failed to include her family history of colorectal cancer in the referral letter to the specialist. She also forgot to include that Robin was passing bloody mucosal tissue by then. Using my system, if Robin had requested a copy of the referral letter to the specialist, it could have been very easily sent via the secure encrypted patient portal. Robin may have noticed the missing information from the referral letter. Robin could have requested an addendum or change to the letter and that it be resent to the specialist. Maybe that would have heightened the suspicion of colorectal cancer generated by the letter.
Doctor Three, another GP, summarized Robin’s rectal bleeding as only several days when in fact it had been seven months. With my system, information from previous visits could be reviewed on the large screen TV at the visit or sent via the patient portal, and if any information not accurate, Robin could easily have me correct it right at the visit or message the office to make the correction in the record so accuracy is maintained. If Robin had had the opportunity to correct her record, then the eventual outcome may have been altered for the better.
Doctor Four, the General Surgeon, made Robin wait 15 months even for a consult, and a further three months for a colonoscopy. If any of the doctors had used the UptoDate links embedded in my EHR sytem, and reviewed the recommendation for rectal beeding in 40-50 year olds, together we would have realized this was an unacceptably long wait for a symptomatic patient with a positive family history of CRC.
As Robin says, “the EHR is about communication and anything that improves communication will save lives.”
Thank you Robin!!!!
The Cancer Olympics is available from Amazon at