Friday, April 07, 2006

Looking back at the first week

I've finished my first week after switching to EMR. Since coming back from March break vacation 3 weeks ago, I've logged more hours than usual at the office, probably 1 to 2 additional hours every evening. One reason for this was the post-vacation backlog, but the EMR implementation has been a major factor. I am trying to customize the software to work best for my practice, I have been charting in the EMR, and I am trying to enter at least 2 or 3 Cumulative Patient Profiles every day. There is always the temptation to play with the software, which I've given into way too often.

This Thursday, much to my surprise, I finished at my usual time. My charts were all written up, all my phone calls and letters were done, and I got away 1 hour after seeing my last patient. I can't imagine that this is going to continue, but it was good to see that it was possible.

I'm starting to learn little tricks like using the tab key to switch between fields, instead of the mouse (tabbing is much quicker if you are using a keyboard). I've started to make a template for the preventive health exam.

There is an area in the software that keeps track of pending consultation requests. When I write a consultation request, the software asks me to put in a date to check for the report. I put in "one day" for one of the requests (this was just for a derm consult for acne, but I wanted to see what it looked like). If it is overdue, it is highlighted in red, and is very obvious. Once the report comes in, you can click on the "received" button, and it goes off your list. Most of my requests are for 3 months from the date sent, but I wonder if I should make this longer; I don't usually know what the specialist's waiting list is like. This "pending report" list may be a problem for me to manage; sometimes patients don't go, and I'll have to be very rigorous about taking pending requests off when the report comes in. I already have 19 requests on the list.

I heard from my regular lab. It looks like my lab reports will start to come in electronically next week. I also received a note from the Ministry of Health: it looks like they're finally giving up on the old style lab requisitions, which have carbon copies (bad for privacy protection), and have to be tractor-fed into a dot-matrix printer. The new lab requisitions are printed sheets; EMR software applications should be able to print them straight from a patient's chart, so that the physician's information and the patient's demographic data is automatically entered into the requisition. That will avoid having to print labels for requisitions. As well, I'll be able to track which lab tests are overdue, since the software will be able to match incoming lab with ordered lab. I may have some trouble with that; patients often don't go for tests, and I have large volumes of results. Wading through pending lab data may not be possible.

Today, we had two people from Nightingale in the office, to do the last parts of hardware and training. They installed and configured the scanner, and did some additional training on how to use it. It scans much faster than my photocopier copies. The scanned copy is kept on the computer, and can be filed electronically at any time; if a patient needs their paper back, my secretary will be able to scan quickly, let the patient leave, and upload to the chart later. I can see that, in the future, printing copies of the chart for transfers, legal reports or insurance reports will be much less of a hassle. I think I will still be somewhat selective about scanning old charts, because the scan is just a picture: it is not searchable. This is good for storage only, which is not very useful if you want to find something in a very large file. We do EKGs and PFTs in my office, and those will be scanned into the file; there is a comment field in the EMR, and I will enter comments electronically rather that writing them on the report, so that I do not have to load the whole picture to look at what I wrote.

Electronic faxing was also configured. All faxes will now come into a computer, so we can upload them directly into a patient's chart without having to scan. We can delete junk faxes without having to print them; we can send outgoing faxes either from the computer or from my fax machine.

I now have 3 patient charts that are electronic only. These are relatively new patients to my practice; we scanned the 2 or 3 papers that I have for them, and I entered the Cumulative Patient Profile directly into the EMR. I put an alert into the patient demographic area saying that the record is EMR only, so that my secretaries don't waste their time looking for a paper chart.

The wireless router is now installed and ready to go. On Monday, I start taking my Tablet into the exam room.


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