Interacting with others in the health care system

The lab called me to ask why I was sending these non-standard pap requisitions. I am continuing to send the computer-generated reqs, with the data circled in red, and a note asking them to please accept this paper. They said that the size of the paper is different, and it is also a different thickness, so this will present filing and tracking problems for them; also, the technologists are not used to seeing the data presented in this way.

We had a nice conversation. I explained that having the pap reqs printed from my computer avoids mislabeling with the wrong patient info (it is done right from the patient encounter, no sending to the front for a label). The pap is tracked from my system, so I can make sure I receive it. As well, I use the tracking for my preventive bonuses (I get a bonus if 80% of women age 35 to 69 in my practice have had a pap in the last two years - pay for quality).

I think the lab will start to see a lot more computer-generated requisitions; it might be good to start planning for it now, while it is just a trickle. They seemed receptive to that argument, so we'll see what happens.

I received an email from a patient, commenting on the fact that the pharmacist told her he'd have to call my office regarding the prescription I signed on the Tablet. We had talked about it at the office, and she thought it was silly as well. Maybe I'll email my College representative to see if he can help; if introducing EMRs is deemed to be important for patient care (as Canada Health Infoway says), then our regulatory agencies can do their part to help.

I have been thinking about coding my diagnoses. If I want to do audits in my practice, I have to enter diagnoses consistently. I can't call a UTI a bladder infection one day, and cystitis the next. Right now, I am entering diagnoses as 3 digit ICD 9 codes. We send bills to the government using the ICD9 codes for diagnosis, so at least I know some of the numbers. I know that Health Infoway is thinking about having everyone use SNOMED, so that different computers (hospitals, home care, physicians) can share data, but there is no way I can learn and use this in practice. It's just too busy. Maybe there is some way they can translate ICD9 into SNOMED.

I am using a flow sheet to track depression. It was surprisingly easy to program. I enter the PHQ9 score, the Quality of Life score from the bottom of the PHQ9, the meds, and comments. I have an alert on the EMR asking my staff to print and give the questionnaire to my patient to fill in the waiting room, so I get the result right away. I referred a patient who had been on several antidepressants (with no change in the score) to the psych intake program at my hospital, along with a printout of the flowsheet. I think this will give the consultant an organized summary of what happened.

I will be taking on a family medicine resident for the first time, starting this July. She will be working with me and my practice partner, and so will see both an electronic and a paper-chart practice. She'll also see the transition to EMR; I think it will be interesting for her.

Michelle