Sunday, November 26, 2006

Tips and Tricks meeting

We had our Tips and Tricks meeting on Friday, at the company's training room. We all wanted to be there together with computers, so that we could log on remotely to our own practices, and figure out how to improve things. We made the agenda ahead of time, and I ran the session.

Here is the agenda; most of it involves how to be more efficient, based on real world practice conditions:

Tips and tricks: how to do things faster and better in the EMR

The patient encounter

Using the Summary page as your default


Drop down lists to save time

Templates: Rourke, preventive health, smoking cessation


Rapid prescribing of new drugs

Loading previous drugs and doing repeats quickly


How to record them fast


How to make sure you remember what to do for next visit


Using drop down lists for speed


Within the patient encounter; how to make the bill quicker

Preventive services

How to generate your reports (and your bonuses)

Using the Summary page to remind you when a service is due

How to send letters to patients who are overdue


How to use them.

Programming one

Examples of some: INR, diabetes, depression


How to generate a Diabetes report

Review of preventive services reports

Scanning old charts

How to get rid of all your paper records (forever).


This took about 2.5 hours. It is a good idea to do something like this several months after EMR start-up, as most of us have had a taste of it, but are not using it to its full potential. It has now been 8 months for my group, and I understand it takes an average of 18 months for the EMR to work well. For keeners like me, it is probably 6 months.

I was speaking with a colleague who had been using EMR for 10 years in his 7 physician practice. 2 physicians never went to EMR, so hybrid practices like mine may be more common than people think. It is interesting that he does not scan; paper copies are kept in a paper chart, so there are still duplicate charts after 10 years. He does not feel that he is using the EMR to its full capacity. Nonetheless, he would never go back to paper, and this is something that I hear universally from people that have made the transition.

I found a very active on-line group for my EMR, and have joined it. I have found several useful tips in the messages.

I seem to have a bit more time at the office; I think I am now more efficient because of EMR and so I can do extra things. On Tuesday, I looked at my list of overdue consultations, and found 7 that were very overdue. We faxed a note to the specialists, with the initial consult request and a letter asking their secretary to tick off what happened (pt never showed, pt cancelled, pt seen and report attached etc). Within two hours, 5 reports came back: 2 with consult notes attached, and 3 stating that the patient cancelled or rebooked for a later date.

My preventive services reports are working. I have given flu shots to 109 out of 213 eligible patients (age 65 and over), which is 51.17%. It says that right at the bottom of the report, and tells me what my bonus code is. On Monday, we have our first flu shot clinic, so my report will look better after that. We sent out letters to all the patients. The reports tell me that we have also sent out 35 letters to patients overdue for a mammogram, and 33 to patients overdue for a pap smear. Several of those patients have had the service because of the letter.

I like this organized approach to prevention; because my group has a common remote server, we are looking at doing this as a group once everyone is on-board with the EMR. We can have a group administrator responsible for things like quality audits, reminder letters/phone calls etc. This is very difficult to do if you have single server boxes in individual offices with no sharing of charts. I am becoming very opinionated about this subject as I see how the EMR functions; the single in-office server is OK for large group practices in a single location, but not for distributed small practices like us.

I tried going through VPN at my office on Monday, which was kludgy at best. The SSHA connection came back on, and we switched to that at noon. They tell me that the problem with VPN is my office router, so I have someone coming to install and test a new super-router on Friday. I have a regular Shelob's lair of wires in my back closet, and several boxes with blinking lights. Managing a small office network is not a job for amateurs; it is worth spending a bit of money for extra help at times.


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