My Month with PatientKeeper

Andy Spooner, MD, FAAP

In general, I enjoyed using the program, for two main reasons: (1) It helped me maintain a consistent problem list on some pretty complex patients, and (2) I could generate legible, detailed notes that supported my level of care without cramping my hand. The following is a list of the problems I encountered, along with the solutions:

1. Bad News: Entering data via graffiti was tedious. I certainly could not record information as fast as I wanted to, or as fast as a student could read it to me. Good News: Once the data were entered, they were available for future reference (e.g., I could print out the CBC from 2 days ago as part of my note if it was relevant to my clinical reasoning).
2. Good News: I could print complete, organized progress notes onto hospital stationery in a matter of seconds. Bad News: The best way to do this is via infrared beaming to an IrDA-compatible printer; my hospital does not have any of these, so I had to purchase a portable one for about $300 (I always wanted a portable printer, anyway).
3. Bad News: The program rounds body weights to the nearest tenth of a kilogram (not nice when you are managing patient who weigh less than 3 kg!). Good News: I simply entered the body weight in grams, and this took care of the data recording problem. Bad News: There was no drug-dose calculation capability, despite the presence of the patient’s weight in the system.
4. Bad News: Pick-lists were populated largely by adult-medicine terms (e.g., Lung Cancer on a list of diagnoses). Good News: The program’s pick lists are very easy to modify on the fly, and, once modified, can be shared with other users.
5. Bad News: When you print a note, PatientKeeper prints the current time, not the time the data were recorded, e.g., the time of the physical examination. Good News: It’s easy to add an "Exam time" item to the pop-up list in the physical examination. Bad News: There is no apparent way to put automatic timestamping into items like this; you have to manually enter the time.
6. Bad News: There’s no template to enter CSF results, like there is for chemistry panels or CBCs. Good News: Once again, you can customize a pick list to handle most of this task.
7. Bad News: There is a lot of space devoted to test results related to the diagnosis and management of ischemic heart disease. One whole button in the results menu bar is dedicated to tests that hardly any child receives.
8. Good News: One can generate multi-line treatment protocols, so that with one click you can record a set of interventions for a patient with a common problem.
9. Good News: One may beam patient data from one Palm device to another (like to your partner who will be covering the inpatients the next day). Bad News: One cannot "synchronize" the data between two devices, so if two people each have a record on a patient, it’s impossible to merge the two records. It was the latter feature that caused me to abandon the product on my next month of inpatient service, since to be truly efficient, one would like for all members of a team to each contribute a small amount of information so that no one person is stuck with graffiti-ing the entire record for any given patient.

Disclaimer: Dr. Spooner has no financial interest in the company that makes the PatientKeeper product.