Monday, February 11, 2008

On-line Support group

I have an on-line support group for my EMR. We have about 70 members; some are more active, some less. There is also an area where you can post useful files, such as an excel gestational calculator template, or examples of EMR processes. The support group is monitored by the company, and sometimes we have replies or comments from them. When someone posts an entry, I get a copy by email; there are anywhere between ten and 50 entries or so per month, so it is not overwhelming.

Occasionally, a new user posts a question, and the replies have been very helpful and generous. I have noticed recently that comments are switching towards data extraction: my colleagues are asking for more Reports (procedures, labs, social history); we are talking about how to enter data in the EMR so that we can get good quality information on our practices. It seems to me that we are now starting to head into "phase II", which is the interesting part of EMR implementation: there is enough data in that we are now thinking about getting data out.

In my own group, I have noticed more clinical queries (or Reports); we can share queries as a group, so you see who programs and runs queries. Some of my colleagues re-use my queries for their own patients (and I am happy to see this happening); there are also new queries being done. I think our coding is becoming better in the second year of implementation; we are now used to entering the ICD diagnostic code routinely for every encounter, and this is no longer an issue. The payback is being able to search for diagnoses consistently. What this means is better data quality in the charts.

My new partner was asking me how to do a referral for audiology; I set this up for her, and showed her how to generate the request as part of the encounter. She told me that most lab/DI/allied health requisitions at her previous office were still done on paper pads. This is rare here; we use EMR reqs whenever possible, or scanned reqs if we have to. I do not think physicians are wedded to paper forms; I see my new partner using EMR forms, because these have been set up in the system. The work for EMR is all upfront: do it once to set it up, re-use it forever. For paper forms, there is no set-up; the work is all back-loaded and on-going: store and find the forms, stamp them with your name, write the patient's name on the form, or send to the front to label. I prefer EMR.

My new partner is not familiar with our local specialists, so I asked her how she was referring. She uses our EMR phone book. We have two phone books: one local (just for my practice), and one shared with all my FHN colleagues at any of our seven locations; I don't use the local one. In our shared phone book, information on the specialist's referral preferences (fax then patient phones, etc) is entered in Notes, and is shared with everyone; there is also a field where you indicate specialty. My new partner told me that she just searches for the specialty, and sees who we refer to. This is a good way to use aggregate information collected by the group; it made me realize that we now have a fairly extensive phone book. The information is used in referral letters as well as on the electronic lab reqs (the address of the specialist we are cc-ing to automatically appears on the req). I have access to a provincial database of physicians in the EMR, but our local phone book is better, because it is more up to date and has extra information.

My current practice partner has now decided that he is going go EMR. I have started showing him some of the really cool things in the system, as he starts to prepare for his transition. He will need to decide whether he prefers desktop or wireless, so I have asked him to try using the resident's Tablet so he can get an idea of both set-ups. We will need to figure out how to make the transition as easy for him as possible; I have printed a list of my medication favourites, and have asked him to pick out some of his commonest prescriptions. I will enter those for him, so he can see how it is done, and can start prescribing. We'll get lab and DI favourites set up for him. I expect that it will be harder for him than it was for our younger colleague; I have a fair idea now of what the likely start-up issues are, and having EMR processes already in place will help.

As for me, my encounters now start with a look at my reminders, the vitals are pre-entered by my wonderful staff, and the on-going meds are already all pending in the encounter, just waiting for a click and signature. I have access to the vast resources of the Internet at a click. One of my patients needed a referral to an addiction centre near him; I googled DART. We were both looking at the site on my Tablet, and decided together which centre he would be referred to. I think that the EMR helps me to be a better physician, and I like that.


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