Sunday, September 30, 2007

Electronic communication in the office

Communication in my office is becoming increasingly electronic. I get 5 to 10 messages from my staff per day (often a patient or a health care worker wanting to talk to me, sometimes a drug refill). Messages are linked to the patient's file (I can just click to access the entire file if needed), and no message gets lost or forgotten anymore. Most of the e-messages I send out are "Actions", or things to do, often stemming from lab results (example, please call patient and tell them that A1C is improved, now at 7.8%; or, INR is 3.8, reduce coumadin to 1 tab daily and repeat INR next wk); typically, there are 5 to 10 of those per day. The "Actions" can be assigned to a group, such as "front staff". This is very helpful if you have several people working at the front; any of my staff can do the requested action, and mark it completed, thus avoiding miscommunication.

I have been assigning complex Actions to my practice nurse, such as discussion of cholesterol results and possible courses of action, or informing a patient about a new diagnosis of impaired fasting glucose. She can often discuss things with my patients over the phone, and she records the phone conversation in the clinical notes; if needed, she will book a patient in to see her. She sends the clinical notes to me for final sign-off when she is done, so I always know what happened.

I use pop-up messaging often as well (Real Popup). This is a small application that pops up in the right lower corner of a PC whenever someone in my office sends an instant message. The message is not part of the EMR. I use this to send a quick note to the front regarding follow-up appointments (example: Mr Smith: DM 3 months). The secretary sees the popup, and gives that patient an appointment marked as "DM", so that the patient automatically gets a weight and BP done when they return, before they are shown to a room. Some of my patients have wondered how the secretary knows what they will be asking for before they even speak! My resident often sends me a popup for a quick question while she is seeing a patient; she also uses this if she wants me to come in and double check something before I see the next patient.

The office environment I have described seems complex, but it works and actually makes the office much less stressful. There is no need to duplicate messages on notes, nothing gets lost, and everything is done. This improved communication is one of the biggest benefits of EMRs.

I have now gone back to signing my prescriptions on my Tablet. So far, I have only had one phone call from a pharmacist inquiring about this, and he was satisfied when informed that it was acceptable practice according to the College of Pharmacists. I think we have progress.


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