Friday, January 30, 2009

EMR transition for the second wave of physicians

My practice partner is continuing on his journey through the transition. It has now been nine months for him. He is definitely not a "techie", but has now adopted the EMR, and has adapted fairly well.

There is no longer any data going into his paper charts; they are now "volume 1" of the record. All his encounters are in the EMR. He started electronic prescribing about two months ago, and is now generating almost all of his scripts through the EMR. Complicated medications continue to be a challenge for him, but he has learned to deal with the commonest issues.

He was still writing referral notes on paper at the beginning, and those were then scanned in the EMR. As well, most of his faxed repeat medications requests were authorized on the paper from the pharmacy, then faxed in and scanned. My secretaries noticed a significant increase in the volume of scanning. He is now doing his referrals via the EMR; if the drugs have been entered in the CPP, he'll just click them on the EMR, and the pharmacy rx paper no longer gets scanned in. If the meds are not in the EMR yet, it is faster for him to write "Ok" on the paper, generating a scan.

He uses flow sheets, especially diabetes and INRs. He has had no difficulties using the eMessaging or To Do notes. He really likes the remote access, and logs on both from home and from the hospital when he is working on the ward.

He is using our preventive services point of care reminders; his rate of flu shots (88%) is better than mine (86%)! He is now part of our FHN's regular preventive mailing program for the past several cycles. Our FHN administrator will be mailing the next letters in early February.

His CPPs are not finished. His practice is older, and has more complex patients with big CPPs than mine. Putting in this data certainly is a massive job, and I think it will be better for him once this is done; it is one tough slog.

He knows how to access and manage his electronic lab data and scanned data. He is now regularly using electronically generated electronic lab reqs, and is using some of our bundled reqs as well. He is less comfortable with DI reqs, but uses them.

We sometimes go over tidbits of EMR information in the evening if neither of us is too tired. That is useful, because it involves things that he has questions about and is very practical and short. He periodically asks me to show him things during the office. My office administrator is very helpful, and will show him things when he is ready as well.

We are now scanning and shredding his paper charts; we have hired a temp to do this. All of the "inactive" charts are gone, and we are now starting on the Deceased. The charts in our back closet are gone. My partner's office currently looks like a bit of a disaster zone, as there are charts piled everywhere, but I expect this to start getting better now. We are planning to move to the new office this summer, and should be completely paper-free by then.

I think that the transition is more manageable for the second wave of physicians, that is, those transitioning once office EMR processes are already in place and working well. There is more in-house knowledge and support. There is still additional stress and time during the transition for the physician, as you have to learn the EMR and put in all the data, but it is less than for the first wave (and that is a good thing). Patience, willingness to learn and to help, as well as a sense of humour all help.

It is possible to have completed most of the transition, even for non "techy" physicians, by nine months. It does require some extra support. It would have been nice to have this for the first wave.

My EMR company has now started web-based training on a regular basis. I think this is very helpful. I attended the first session; what happens is that you have a trainer and several physicians phoning in via teleconferencing. Everyone logs in to the same website, and the trainer demonstrates various aspects of the EMR. This is a good way of doing training for IT, because you can see what is happening right in front of you. The session was 1 hour, which is a good length, I think. We will be having our first user conference in May, and I've been asked to do a seminar. I'm not sure what I am going to do yet, maybe "the efficient office visit".

We will be having an EMR booster session for my FHN in mid-February. I am now familiar with the features in the new version, so that I can demonstrate the most important elements. I think we are starting to do better with our ongoing training.


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