Friday, March 07, 2008

Wag the dog: of forms and cookies

I am not the only one who thinks these proprietary forms are simply bad care. Here is what a colleague in my on-line EMR support group said:

"I hate the multiple forms we have to use and I have dutifully filled out the exact forms they wanted to make the clerks' lives easier. I now take the stand that if I can increase the completeness of my record and as long as all the clinical info is there I will use the form of my choice and it is up them to convince me otherwise.

However when I talk to them I am very nice and it is amazing what a bribe of cookies can do :) "

I think that perhaps we should form an alliance, and collectively refuse to send or receive proprietary forms. After all, the EMR based forms are typed, are legible, and contain all the needed information. Bring on the cookies!

I am now generating my pap reqs from the EMR; we attach the paper based req on the front, with no information other than the label. The proprietary req says "see attached"; the real information is on the EMR req. I wonder what would happen if we forget the patient label. My public health reqs are now generated from the EMR, which stores the appropriate code; a paper req is clipped to the front, with "see attached".

My practice partner has now decided that he would like a Tablet, so we've ordered one for him. We've also ordered 3 network printers, one for his consult room and one for each of his exam rooms. The total hardware cost to equip a new physician is about $3,500, far less than what it costs to start.

He likes the electronic labs; this is one of the best parts of the EMR. Our community-based labs really have it right; the reports are unbelievably fast and efficient. I probably shouldn't complain so much about pap reqs; I think I'll send my lab a box of cookies, they deserve it. My partner started using the flow sheet for his INRs on the first day; our secretary showed me a message from him to call the patient about the result. He now knows how to use the e-messages and task lists. Paper-based INR sheets are gone as of now.

He seems intrigued by templates; I showed him how to use a Rourke well baby template, and how the EMR remembers the lot number and expiry dates for immunizations. I also showed him how an assessment in the encounter can be simultaneously placed in the CPP, the "write it once, have it go three places" principle of EMR. I will be away for March break next week, and I am hoping he will find some time to play with this. He does some in-patient care at the hospital; there is access to the EMR in the doctors' lounge, and I told him that it would be pretty easy to have it on the floor where he works. He can log on to see his office lab results, and won't have to call our secretary anymore.

I am starting to find more ways to look at my data. For example, there is a place in the EMR that tracks my referrals. In the past 30 days, I've made 8 referrals to social work, 5 referrals to dietitians and 2 to our clinical pharmacist. The total is 15 referrals within the Family Health Team. These represent new things for our health care system, as they would not have existed prior to the FHT. Remote access to our EMR for our FHT Allied Health Professionals has just been enabled, so those referrals will soon start to be generated and recorded within the common e-Chart.

As far as specialist referrals, the most common is Derm, with 6 referrals. Total number of referrals (specialists, programs and allied health): 60 in the past 30 days. 15 / 60, or 25% are within the FHT. This 25% represents the beginning of an integrated system.



Ian said...

hey Michelle,
If you're technically inclined.... we took MS-Excel and got read-only permission to the database that is behind our EMR. We can now track all kinds of stuff though charts and graphs to see how our office is doing. It took a bit of practice but the company was happy to help. I order the same CT scan 2-3x a day -- I'm going to try the box of cookies and paper requisition trick. Thanks Ian.

Michelle Greiver said...

That's pretty cool! I don't really know if I can do that with my EMR, but it would be worthwhile asking. What I often do is copy/paste reports and lists into Excel, so I can get some numbers out of them