Friday, November 03, 2006

Helping others in my group

One of the benefits of starting EMR as a group, rather than individually, is that we can help each other. At our recent meeting, it was clear to me that I was the furthest along, although others had good ideas. Because the nine of us work in 7 different practice locations, we don't meet all that often; we use email, and recently also the EMR's internal messaging system. We decided to have a "Tips and Tricks" afternoon at the company's training room, and this will be on November 24th.

The plan is for us to log on remotely to our practice EMR during that meeting, so that we can make changes (such as new flow sheets) directly. My group's IT lead physician will help me set an agenda; I will circulate this prior to the meeting to see if there is anything people want to add. We've invited the other FHN's IT lead, so that she can bring things back to her group; her FHN includes one 6 physician group practice and one 3 physician group, so it is not as scattered all over the place as ours.

Some practices are not using the scanner. EMR not only involves software, it also involves learning how to use new (and sometimes unfamiliar) hardware quickly and effectively in a busy office. I did a brief demonstration of how to use the scanner during the meeting; I talked to my staff the next day, and they offered to help as well. Probably the best way to show how we use the EMR is to have a staff member from another office visit my practice on a Friday (since I'm not there Fridays); this happened today.

I have been away at a conference for the past two days. In the evening, before supper, I have been logging on to my practice, and signing off lab work, and scanned reports. I received several messages from my staff, wrote a couple of prescriptions, sent notes to my staff to call patients about their results, and wrote some lab reqs. I also had an email from a patient who was worried about his lung function test; it had been scanned in the EMR, I saw it, and sent him a note that it was normal. One of my patients had received a flu shot at another office in my group; they entered it in the EMR chart, and sent me an internal message to let me know.

This work for my practice took about 45 minutes. I consider going to a conference part of work, so told my staff that I would be logging on daily. It is extra for me, but really does take a load off my practice partner; a big part of covering for another physician is reviewing all the paper that comes in. I am much more efficient at reviewing results for my own patients, because I know them. It is becoming more important for me to let my staff know whether I will be logging on when I am away, and I have to be explicit about this. If I do log on, my partner is only responsible for looking after critical results.

A couple of physicians in my FHN are part of our palliative care group. I wonder if I should ask the nurse coordinator to direct my patients to them when I refer. They would have access to the chart. It would not always be possible to use the EMR during a housecall, since not everyone has high speed internet; they would have to print the CPP ahead of time, and then scan notes in afterwards. However, if there is access, then all the changes are live in the common chart. They could even write a prescription in the EMR during the housecall, and have their secretary print and fax it to the patient's pharmacy (just like I am doing from my conference). I would always be able to know what is happening, and if I made any changes, my colleague would know. Any home care, specialist, or test report that came would be scanned in, and would thus be available to the team. I should talk to my colleagues about this.



Anonymous said...

Michelle, what you describe is the creation of an EMR User Group. This is exactly the type of structure that facilitates better care and greater efficiency - drawing from the experience of others and learning from physicians and staff in your individual group. It could be very useful to coordinate with other medical practices in your reachable vicinity and set up intermittent learning sessions where you share your pooled expertise. Once you get beyond the IT piece where everyone is comfortable with the EMR it starts to get fun. You then have the ability to identify common patient groups and see how you are doing with clinical targets and measuring progress in conjunction with colleagues.

Michelle Greiver said...

Thanks, Alan. A user group seems like a good idea at this time for us, as we are just past the beginning stages. I remember reading in one of the RAND reports on Electronic Health Records that any innovation becomes increasingly valuable as more people adopt it--shared expertise being one of the reasons.

I am looking forward to the fun part! I think I am starting to see glimpses of it already.