We now have my FHN’s results for our preventive services:
Children’s vaccinations: 98%;
Pap smears: 74%
Influenza vaccinations: 71%
We mailed out 7,666 reminder letters in the past year. Our FHN admin is emailing individual and group results to each physician.
The results are OK. I think they are not as accurate as they could be, because it was hard for us to figure out how to keep our patient rosters up to date at the beginning, so some patients are on the list and shouldn’t be. We are now much better at it: most practices fax the monthly update to our FHN administrator, and she enters the changes in the EMR. As a result, our patient databases are becoming much cleaner. I received a note that the Ministry of Health will soon be sending us our patient Roster lists electronically, so that will help--if it does happen and if the EMR company programs an interface for it.
I expect that our preventive results will be better in the second year because we are better organized and we have worked out the initial problems. I think this was a good experience overall for my group; I am now getting requests from several colleagues to start a Fecal Occult Blood screening program.
We are about to do our next mailing; this is now routinely happening every three months. We are also organizing a system to phone patients who have already received two letters and have not responded yet.
The five new physicians joining our FHN will be part of this, once they implement the EMR; my two practice partners have started, and we will do their initial mail out this month. Having a project that you do as a group is a good idea: it will make you function as a group (groups don’t really happen unless you do things in common), and these projects can be used to help with EMR implementation, because they add value to the EMR.
The diabetes project is going faster than expected. Most of the flowsheets have now been put in; the work is all being done remotely, since we no longer have to go to each practice to get data from paper charts. We are now going to start putting in automated reminders for diabetes care.
I have now visited five practices in my FHT. There are different things happening at each practice, but I am starting to see a couple of things that are common. Several of my colleagues wanted the vitals and current medications to load automatically into the encounter. I showed them how this is set up in Preferences, and we changed it while I was there.
I installed several batched lab requisitions at some practices, as well as requisitions for Diagnostic Imaging. For other colleagues, I went over how to prescribe using the favourites list, and how to quickly enter ICD codes for assessments. I re-worked saved letters and handouts to make them a better fit, after asking what my colleague needed; several people will now be doing sick notes directly from the EMR.
At several of the practices, I also spoke to the front staff. I have a CD with my scanned requisitions and patient handouts, and I installed this on a networked folder on the front computer.
I can see that this type of individualized assistance is of value. I was able to fix some annoying problems fairly quickly, and I think everyone was happy with the experience. I spent 1.5 to 2 hours at each practice, and the visits were pre-booked: the physicians cancelled appointments to make sure that we could sit together. I don’t expect that everything we discussed will be done, but I know that some things will, because we changed the Preferences and practiced together; if two or three common things work better, I think that’s pretty good.
It was interesting that while I was at their office, several colleagues told me that the computer made them feel “stupid”. You really have to wonder why this is happening to intelligent, very competent physicians. I think we have a lot of experience and knowledge about caring for patients, and we don’t have the same for computers. I reminded my colleagues that the amount of education and training we receive in Information Technology is several orders of magnitude less than what we receive in medicine; we are physicians and not IT specialists, after all. I don’t expect my lawyer to solve my computer problems. The stupidity lies on the side of the machines: if they worked perfectly, we wouldn’t have to deal with their frequent mood swings and reboots. My patients are used to hearing me vent at my stupid Tablet.
I went to another group on Tuesday evening, as part of the “official” Peer to Peer program. The issues were somewhat similar; their administrator was there, and we discussed work flow issues for different conditions, such as diabetes; I have now posted several entries on workflow at EMR Advisor. I showed how to make new templates using pieces of old templates. This took about two hours, which I think is about the right amount of time; more than that and everyone gets a headache.
Little pieces of integration are starting to happen on their own. I am receiving the occasional email about patients; I received a note from a specialty clinic asking if we would prefer to receive consultation letters via email. Even if the “System” makes it difficult, electronic communication is starting; perhaps we can use “going green” as an excuse to avoid paper and fax.