I spoke with the pharmacist across the road from my office. He gets inspected periodically; if the inspector sees a script signed electronically, that can lead to trouble for him. At the College of Physicians and Surgeons, they told me that this policy comes from the College of Pharmacists. This is not something I can change for now, nor do I want to cause problems for pharmacists. I am now printing and signing my prescriptions in blue pen.
My lab and my EMR company have been talking with each other; the pap requisitions will be reprogrammed soon so that they conform to the Ontario Laboratory Accreditation program. It looks like that problem is about to be solved through cooperation, which is good to see.
I have found access speed to be inconsistent. Sometimes it is OK, and at times, it feels like data is coming through an eyedropper. The government told us they can upgrade our internet lines, so I applied for an upgrade. I received a new line, and a new modem, which the people from SSHA installed. However, I had to connect this to my network myself, and I had no idea how to do this. Trying to connect wires by myself did not work. It took the better part of an hour last Thursday morning, on the phone with the SSHA helpdesk, to figure out what to do (something to do with IP config). Then all my printers went off line; this did not get fixed until late afternoon. The new line is not faster, but I understand that they are working on this.
These are complex systems, and problems will happen; I sometimes miss the simplicity of paper. I still think EMR is the way to go, but I was not happy that day.
I found out that if I print a handout from an internet site accessed within the EMR, this is tracked in the patient encounter. I like that; I print a lot of handouts (from my own website, from the College of family physicians of Canada, from the AAFP website). Now I can see in the record that I gave the patient a handout. I can also see if I generated a cytology req; pretty soon, I'll have the rest of the reqs as well. I've also started printing some XR requisitions. I am beginning to see how this can capture and track a large part of my process of care. I don't know if it will make those processes better, but at least I'll have a chance to look at what I am doing.
I have been talking with a colleague about joining us; she is thinking about starting a new practice. If this works out, she will start paperless from day 1. I have a student coming in two weeks to start scanning all my old charts, which we will then shred. This will free up space, allowing us to take on an extra physician (but only a paperless one).