Sunday, October 14, 2007

Back to paper

Due to personal circumstances, my practice partner had to suddenly be away and unavailable from his practice for the past week.

What that meant was that I was looking after two practices, one EMR and one paper-based. This was a somewhat rough way to compare the two systems. The picture above shows what the front of the office looked like after four days, and there were more charts piled up on my partner's desk. He is very meticulous, and wants to look at everything, so nothing got filed away; we must have had well over 150 charts out.

The logistical problems for my staff were tremendous: trying to find a chart to attach a result to quickly became very challenging: labs often send a partial result first, then a final result; this leads to two separate chart searches. My secretaries stacked the charts in alphabetical order, so that there was some chance of finding the right file.

I had trouble finding data in the paper chart. Looking for previous results meant having to thumb through several papers instead of doing a simple search or clicking a checkbox to get a list of results. Labs, consultation notes and Diagnostic Imaging reports were all mixed together. The CPP was up to date, but drug prescriptions were often very hard to follow, as they were in the clinical notes. There was no easy way to refill prescriptions, those had to be written by hand. My partner keeps excellent notes, and has handwriting that is much more legible than mine, but the logistic challenges were still large.

I know that many of my colleagues who have gone to EMR have stated that they would never go back to paper. Having had to go back to paper for a week, I can unequivocally say that no, absolutely not, under no circumstances, and no way would I go back to paper. It doesn't work.

Having said that, EMR does present its own challenges. My resident is on block time (in my office most of the time) and was a great help in the past week. However, her Tablet went on the fritz on our busiest day (Thursday). It suddenly refused to load the EMR software properly. I have a backup laptop for those occasions, but had lent it to my Nurse who takes it to my colleague's office Thursday afternoons. My resident went back to paper (since she was seeing my partner's patients), and my secretary called the EMR company. They had to "remote" into the Tablet (that means they take control of it from a remote location). Apparently, the hosts had disappeared; I don't know what that means, it sounds like something from the hospitality industry. They reintroduced the hosts, and the Tablet was fixed and happy. This took about 45 minutes.

I have been asked what I do when my Tablet crashes. Computers crash, and they usually do so at the worst times. If mine crashes in the middle of a patient encounter, I either leave it to reboot in the room (if I'm doing something else such as examining the patient), or I put in my consult room to reboot and I go take the backup laptop. The backup laptop is left turned on and ready to go; I just log in. You really have to have some redundancy; however, as noted above, even the best laid plans sometimes do go astray.

I do not pretend that EMR systems are free of problems and aggravation (they are not); however, the past week has made it very obvious to me that EMR is far superior to paper. Just try asking your kids to function without the Internet--asking a computerized doc to go back to paper will lead to the same reaction.


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