Saturday, October 07, 2006

Tracking patients, tracking reports

The EMR allows tracking of several things. I've already mentioned tracking of lab results, which is not perfect, but is much better than what I had before (nothing). It tracks DI reports, and also consultation requests. I have three folders for tracking requests to the outside (lab, DI, consults).

I had a look at my consultation requests folder recently. The largest number are for derm referrals (I probably over-use this); Second was for ENT. When I send a consult, I can put in a "date expected" in a drop down field; if the date is exceeded, the request is highlighted in red. One of my patients had a rather serious medical problem, and no report was received. We sent in a note to the specialist, and they told us that she had cancelled. This lady comes in fairly often, so I will ask her what she would like to do. When a report is received, I click off "received"; in the future, perhaps we can do audits to see what actual times between referral and report are.

There are therefore a couple of advantages to this
  1. you can get a sense of what your referral pattern is like
  2. you can track patients to see what happened
  3. you may be able to get a sense of waiting times. That might be useful for wait time management for our health care system in the future
I also track "follow-ups" in my office. When someone needs a follow up (1st rx for HCTZ: needs K+; 1st rx for ACEI: needs K+, creatinine; etc), this shows up in my Summary screen when I load up the chart, to remind me. However, it also shows up as a list of Follow-ups, so I can see which ones were missed. A common miss seems to be the follow up for depression therapy, after a patient was given a first script for a SSRI. They don't book the follow up appointment with my secretary when they come out, and they don't come back. Guilt and hopelessness are features of depression, so it is no wonder this happens. Right now, I don't have the resources to do something about this; however, once we have the FHT going, I wonder if it might not be good to assign a mental health worker to phone these people. Same thing for people who have missed more than one of the recurring DM follow-ups.

There are problems with doing this, such as how much is the physician's responsibility and how much is the patient's. Tracking does make recalls for chronic disease management possible; we already do it for preventive services, such as influenza or pap smears. We'll have to decide how much is possible to do, which problems to target, and how to do it.


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