Wednesday, May 03, 2006

Templates and handouts

We got rid of the old computer; we no longer need our previous billing/scheduling program, and the PC was just taking up space. I took the hard drive out, and smashed it with a hammer.

I found out that most of the templates that I have been using were programmed by my colleague, Dr. Scot Mountain. Likely all EMR software companies have repositories of useful templates; I wonder if there is a way to share them across platforms--likely not, which is too bad. I used pieces of Dr. Mountain's template to complete a template for the initial full physical: I programmed the preventive health tables that I use (based on the US and Canadian Task Force's A and B recommendation for prevention), and added the physical exam that was already programmed. You end up with a very full assessment that loads with just a few clicks. I'll use that for a while and then share with my colleagues in my Family Health Network if I see it works well. I'll do templates for follow up preventive health exams.

I also programmed a handout based on the PHQ-9 for depression. This is a questionnaire based on the DSM IV depression symptoms; the patient fills it out, and the score is very useful for tracking remission. One of the problems I have with it is that the patient often fills it out at the end of the visit, but I need the score to see how they are doing at the beginning of the visit. What I did is I put the PHQ9 as a handout in the EMR. When I finished seeing one of my patients, I put an alert on her electronic chart to print and give her the questionnaire to fill out in the waiting room next time she comes in. We'll see if that works.

We had a meeting for the physicians in my FHN yesterday. Not everyone has switched to EMR yet; most people are quite a bit more tentative than I am. Several of us are now prescribing electronically, and some have started completing CPPs. We were told that the VPN for remote access should come in sometimes this month. We talked about the glitches that we had been experiencing (especially scanning), and about how to share templates. What I think we may do is go back for a booster educational session in a few months.

Nightingale sent us a note about enhancements. We will be getting the ability to link to educational sites directly from the application. I think that's very useful; I often look up formulary drugs at the Ministry of Health's website, and I use the OntarioMD site as well. I use their eCPS drug look-up (much faster than using the large blue book to look up drugs), and some of their resources, such as the Stat-ref textbooks. I had a patient with febrile neutropenia on Monday, and having Stat-ref there helped me to know what to do. I wonder if I am allowed to copy some of the content and paste in the CPP of patients with rare conditions so I know what to do when I load the chart.

I worry a bit about linking from the EMR to commercial sites, because I know some of those collect information about me via cookies and other things (it says so right there on their privacy policy). Getting information about physician's prescribing habits is a valuable thing for pharmaceutical companies, and I don't know what the potential for web-based programs to access what I am prescribing at the point of care is. I am going to be very selective about the sites I link to.



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