Thursday, May 11, 2006

Power failure

This Monday morning, there was a power outage at the regional hospital where our server is located. The hospital's computers all shut down, and so did ours. We have a UPS (a back-up battery that the computer is connected to), but I guess it doesn't power the server for that long. We had no EMR for 2.5 hours.

My secretary could not book appointments; I had no electronic charts. I still have the CPP on paper, and will continue to have this (although not updated) once the charts are scanned into pdf. What I did was write notes on paper for later scanning or transcription into the EMR. Long notes were scanned; brief notes were transcribed. I had to write 7 prescriptions for one patient by hand, which was beyond tedious; it is amazing how fast you get used to EMR prescribing. I think if this happens again, we'll do the same thing; I will probably not write multiple repeat scripts, but will tell the patient we'll print and mail to them/fax to their pharmacy once the power is back on. I will not have access to lab reports/DI reports/CPPs; it will feel like walk-in work, where there is no access to patient information.

Physicians in my group were very upset with this, and we had emails flying back and forth. It can be challenging for the IT lead to maintain enthusiasm for EMRs in the face of the inevitable problems and delays. Starting an EMR is a bit like being pregnant: you get nausea and swollen ankles first, and the good part doesn't come until much later. EMR transition is easier for some than others: I told one of my colleagues that I was having a normal vaginal delivery, while he was having a difficult C/section.

I wrote a template for the sore throat score. Notes in the EMR look very complete due to templates: you can dump a lot of information into the record very quickly. On paper, the default clinical record is that nothing was done; on an EMR template, the default can be that everything was done. For example, my preventive services template shows that all services were provided; if I am not careful, and do not uncheck what I did not do, the record shows I did everything. Peer reviews of charts for the provincial colleges may look very different on EMR.

I had a look at my list of favourite drugs. It has now been just over a month that I have been prescribing electronically, and the prescription counter just went over 400 (multiple drugs prescribed at the same time count as a single prescription). The medication Favourites likely represent a pretty good overview of my internal formulary. I have no clear idea of why I favour some particular drug in a class; I wonder if I should review this. I wonder if it will be more difficult for drug reps to influence doctors using EMR, since prescribing a drug on the current "favourites" is easier than entering a new drug (all the information is pre-written and fills by itself after a few keystrokes).

I entered a link to Canada411, my College's physician look-up, and Canada Postal code finder on the new quick link icon provided in the EMR. That will help my staff find the information from within the program.



emr and hipaa said...

I LOVED your comparison of EMR implementation to delivery. Not to mention how I feel being the IT advocate for the EMR and the nausea and swollen ankle effect. In fact, I liked it so much I'll be posting it to my EMR and HIPAA blog soon.

I love the blog. Keep up the posting.

Michelle Greiver said...

Thank you! It can be very scary doing this. I heard somewhere that implementation failure rates are around 50%. As well, there is an article on problems in hospital computerization in the current issue of CMAJ

I still think it is the right thing to do; this is an investment in the future. I just wish it was a little easier for everyone.


emr and hipaa said...

It is a scary thing to do, but just remember that EMR offers a lot of advantages that you start to take for granted once you have it.

I wonder where they get the numbers for failure rate. I think it's way to hard to put a number on and don't think they have much value.

Prakash said...

I guess what any one who plan to do a EMR Implementation needs to to is to plan the implementation

The implementation phase can be sub categorized into the following phases:
1. EMR Implementation Planning
2. Prepare your practice
3. Build and Customize your EMR Software
4. Install & Test
5. Plan the changeover strategy
6. Go-Live
7. Maintenance

And yes not to forget the power requirements :)

Our company specializes in EMR implementations In fact we have developed many EMR systems as we know That each Practice has its own needs and budget consideration.

Abdul Quddus said...

I think that there are two views points to be considered when strongly advocating the use of EMR in practices. For a Doctor it needs to easy to use and save time so that more time can be spend on the patient. Currently we have many vendors with different types of EMR that are so hard to use that it simply puts them off. I think healthcare technology companies need to develop product after regular interaction with doctors to ensure that they provide just what is required. At binaryspectrum we have developed our healthcare solutions after spending countless number of hours with doctors to ensure that its work flow is kept simple and intuitive. This is then followed up with a period of Beta testing in real time environment before it is offered as a product in the market.

steel said...

Wow gr8 job...........Thanks for sharing and keep updating.