Friday, March 02, 2007

The Enterprise module: functioning as a group

I am now beginning to explore the enterprise module. This is the area for group functions, and is one of the most powerful features of the EMR.

I think of "enterprise" functions as things that we should be managing as a group, rather than individually, such as
  • quality improvement projects (example, meeting targets in diabetes; protocols that the whole group agrees on)
  • Shared care, such as prenatal care or palliative care
  • Services that one physician is willing to provide for the group (example, IUD insertion)
  • Allied health professionals attached to the whole group rather than to individual physicians
It is very clear that the majority of family physicians in Ontario practice solo, see the ICES Primary Care Atlas, chapter on Characteristics of Primary Care. This will not change much in the next few years, because it is too difficult to break leases, there are staff issues to consider, etc. However, practicing solo no longer means automatic isolation; my group is now linked through our common EMR.

I have started to use this. A couple of my colleagues wanted a copy of my diabetes flow sheets, and I just installed those on their office application. I helped another colleague remotely with the process of doing consultation letters. I figured out how to access the different schedulers. We have started talking about how to do shared prenatal care across the whole group, and about what would be best practices.

The team pharmacist has started logging on remotely to learn about the application; there were a couple of things that I needed to change in her permissions (the pharmacist profile), and that has been done. These permissions are set for the group so they don't need to be replicated.

My filing cabinets are gone; it is amazing how much space I have at my office. If my partner ever decides to go EMR, we will not need a single filing cabinet for charts. I am now trying to decide if the space should go to a third associate, or whether I should use it for some of the new allied health professionals we will be hiring for our Family Health Team. I am leaning towards the latter; there is still so very little inter-professional health care in Canada that there will be much to learn and invent in small family practices. If, for example, a social worker works out of my office some of the time, his or her schedule is always immediately available to the whole group through the single log-in. Any of our group's support staff can book the appointment and see the location without having to call. I think it will also be interesting for me to have lunch-time conversations whith whoever we hire.

This, in my mind, is what lies beyond the EMR transition: EMR ver2 can let us do as a group what we cannot achieve individually.


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