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1、EXPERIENCE&REASONOfLobsters,ElectronicMedicalRecords,andNeonatalTotalParenteralNutritionDennisT.Costakos,MD,FAAPDepartmentofNeonatology,FranciscanSkemp-MayoHealthSystem,LaCrosse,Wisconsin;DepartmentofPediatrics,MayoClinicCollegeofMedicine,Rochester,M
2、innesotaTheauthorshaveindicatedtheyhavenofinancialrelationshipsrelevanttothisarticletodisclose.ABSTRACTAttheMayoHealthSysteminLaCrosse,Wisconsin,thereare1000infanttotalparenteralnutrition(TPN)ordersplacedperyear.Itisthemostcomplicatedorderthatthephar
3、macyfills,soarecentpeer-reviewarticleinPediatricsmovedagroupofustoactionatourcentertobuyordevelopaTPNcalculator.Wedidthisbecausenostand-alonecommercialcalculatorswereavailabletous,andexpensiveelectronicmedicalrecordstypicallydonotincludeTPNcalculators
4、forneonatalpatients.Thenewsoftwareincludesdecisionsupport,andtheordersareconsistentlylegible.Thephysicianperformsfewercalculations,andtherearenomathematicalerrors.ThisarticleexaminesthebroadersignificanceofprovidershavingtowritetheirownTPNsoftware.ATT
5、HEMAYOHealthSysteminLaCrosse,Wisconsin,MaybethenewEMRsystematCornellincludedaTPNthereare1000infanttotalparenteralnutritioncalculator.MaybemostEMRsdonotincludeTPNcalcu-(TPN)ordersplacedperyear.Itisthemostcomplicatedlators.Imadesomephonecalls,andIlear
6、nedfromtheorderthatthepharmacyfills,soarecentpeer-reviewdirectorofalargeacademicNICU(heprefersnottobearticle1inPediatricsmovedagroupofustoactionatournamed)whatoccursathiscenter:“NICUstaffandresi-centertobuyordevelopaTPNcalculator.dentsstillsubmitTPNor
7、dersonpaperdespiteanexpen-ThisarticlebyLehmannetalofJohnsHopkins,“Pre-siveEMR,andlunchtimealwaysmeansnumerousventingProviderErrors:OnlineTotalParenteralNutri-phonecallstopreventerrorsbecauseofmatherrorsortionCalculator,”relatesthattheJohnHopkinsMedic
8、alhandwritingthatcannotbedecipheredbyanurseorCenterwasabletotakepaperorderingofneonatalTPNpharmacist.”andmakeanelectronicorderingprogramwithin3ThesecondthoughtIhadwasthatreimbursementweeksbyusingin-housetalent.1Moreimportantly,theyruleslargelydon’tre
