Friday, March 24, 2006

First EMR steps

We had our first EMR class on Tuesday. I have to admit that it looked overwhelming at first; there seems to be so much to learn. We learned about the basic set up of the electronic patient chart, how to generate electronic lab and XR requests (and make sure that they are tracked), and how to document a basic patient encounter. I'm sure I forgot 3/4 of it; it's a good thing we have notes and handouts to take home.

After I got back to the office, I thought that I might as well start trying a couple of things. My Tablet is still sitting in my consultation room, wired to the network. I excused myself during a patient encounter, went to my consultation room, and generated a prescription from the EMR. It took about 5 minutes, and it was probably good that my patient did not seem me fumbling around. I had to read it carefully after I printed it; a local pharmacist told me that he had been seeing several odd-looking prescription instructions from physicians who have recently switched to EMRs. It looked reasonable, so I signed it and gave it to my patient. The good thing was that the drugs on the prescription were now stored in my list of "favourite drugs", so prescribing will be faster next time. As well, I did not copy the medications in the paper chart, as this would be duplicate entry. The meds were automatically entered in the Patient's electronic cumulative patient profile. The pharmacist won't have to call me about an illegible prescription anymore.

By Thursday night, I'd written 39 electronic prescriptions; I'm getting better at it. However, I've turned off the automatic drug interaction software. I couldn't figure out how to accept and print a prescription if there are interactions that don't matter; since we have the EMR2 seminar next Wednesday, I will ask then. I can see how some potentially useful (but irritating at the beginning) parts of the EMR can be bypassed; workarounds must be very common. I should probably take a refresher course in a few months.

I've also started documenting patient encounters in the EMR. I often write charts at the end of the day, so I thought I'd try a couple then. I type faster than I write. That actually wasn't too bad. I found a couple of useful templates (pre-made forms), and used those for patients presenting with a cold, for a couple of well-baby visits, and for complete check-ups. On Thursday evening, I wrote about 1/4 of the charts electronically. By the time I start using the EMR in the exam room with patients, on April 3rd, I'll still be slow, but not a total neophyte.

I tried entering my first Cumulative Patient Profile (CPP), which took me about 20 minutes of my lunch hour. I should have started with a simpler CPP, not a patient with complex medical conditions. I am very picky about my CPPs, want a lot of detail in them, want to do it right, and I'd like to make sure I can search them in the future. I'm going to start slowly with CPPs, and maybe do one to three daily. Some data, such as medications, will be entered directly from the clinical encounter.

The software offers a lot of customization for the CPP: you can set up categories and sub-categories for many things. For example, for "smoking", I set up a "never" category, a "social smoker" category in addition to the pre-set category of number of cigarettes/day and age quit. It is more time for me now, but will pay off in the future once this is all set. It reminds me of my electronic financial program, Quicken; I also had to find out how to do everything at first, and now I can't imagine doing my home or office bookkeeping without it. I bought my first copy of Quicken in 1993.

I typed my first consultation letter in the EMR. I signed it on the Tablet's screen, which was kind of interesting.

My front staff is calling the helpdesk less often. I've called a couple of times; once, the nice man at helpdesk took over my computer remotely; it was very strange to see the mouse moving about via an unseen hand.

My wireless router was delivered this week. I expect it will be installed sometimes next week; maybe I'll try unhooking the Tablet and bringing it into the exam room once that is done.


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