tag:blogger.com,1999:blog-20382865.post2455768684325094650..comments2023-05-19T05:11:35.329-04:00Comments on Dr. Greiver's EMR: Not yet good enoughMichelle Greiverhttp://www.blogger.com/profile/15528486116262255346noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-20382865.post-18762281630379990662010-08-15T17:28:45.452-04:002010-08-15T17:28:45.452-04:00We've been following the progress towards impl...We've been following the progress towards implementing an EMR for quite a few years, and you have documented this extraordinarily well.<br /><br />Resources for others include http://www.ready4ehr.com to determine readiness and then http://www.emrconsultant.com to assist with selection.<br /><br />And, again, congratulations on your journey!Eric 'EMR' Fishman, MDhttp://www.emrconsultant.comnoreply@blogger.comtag:blogger.com,1999:blog-20382865.post-27221504649050606802010-08-06T07:10:52.336-04:002010-08-06T07:10:52.336-04:00Dr. Griever, great blog, thank you for sharing you...Dr. Griever, great blog, thank you for sharing your journey transitioning to EMR.John Curriehttp://www.curriewiltshire.comnoreply@blogger.comtag:blogger.com,1999:blog-20382865.post-21039660908397650272010-05-07T06:11:15.044-04:002010-05-07T06:11:15.044-04:00Thanks for sharing this info.Thanks for sharing this info.EMR Implementationhttp://www.implementhit.comnoreply@blogger.comtag:blogger.com,1999:blog-20382865.post-85414253664218734992010-02-07T15:15:05.572-05:002010-02-07T15:15:05.572-05:00Hi Dr. Greiver,
Since you have an established clin...Hi Dr. Greiver,<br />Since you have an established clinic with an EMR syste I would like to get your insight on what the next steps would be for a clinic like yours when dealing with labs, pharmacies and other clinics who are still in the paper world.<br /><br />I look forward to your thoughts on the matter.<br />-RoRonak Patelhttps://www.blogger.com/profile/08253861751441719801noreply@blogger.comtag:blogger.com,1999:blog-20382865.post-34157122134108411832010-01-12T20:00:19.838-05:002010-01-12T20:00:19.838-05:00Jean-Francois, please send me your email address (...Jean-Francois, please send me your email address (to mgreiver@rogers.com). I will forward you the information.<br /><br />MichelleMichelle Greiverhttps://www.blogger.com/profile/15528486116262255346noreply@blogger.comtag:blogger.com,1999:blog-20382865.post-64975850135019027182010-01-12T11:46:26.265-05:002010-01-12T11:46:26.265-05:00Michelle, I read your blog each month. It's he...Michelle, I read your blog each month. It's help me a lot in our EMR.<br /><br />Can you send me some information to learn about Advance Access. Nobody have implemented it in Québec and I want to try it but with a fine preparation.<br />Thank youJean-François Rancourthttps://www.blogger.com/profile/00401762346121978860noreply@blogger.comtag:blogger.com,1999:blog-20382865.post-32406427961147494842010-01-05T21:40:19.115-05:002010-01-05T21:40:19.115-05:00Thank you for your thoughtful comments. I admit t...Thank you for your thoughtful comments. I admit that I have considered stopping this blog; I don't really know if there is value to doing this, and most of the initial implementation issues internal to the office have been worked out. <br /><br />Your comment is with regards to efficiency. You are correct, the EMR decreases "visit" efficiency, at least initially; visits take longer, charting takes longer, and it takes an inordinate amount of physician time to enter the initial data that is transferred from the paper chart. <br /><br />I do not think that EMR decreases visit length, or the amount of time spent charting for the majority of physicians. If efficiency is defined by those measures, then having an EMR does not make a physician more efficient. <br /><br />I took my data on visit numbers from the spreadsheet supplied by ICES; this is derived from OHIP (our provincial health insurance), and reflects average number of visits for a physician with the same age/gender practice as mine, practicing in a Family Health Team. The spreadsheet shows that physicians in Fee for Service bill for more visits for the same practice profile--they see their patients more often.<br /><br />FFS rewards you for seeing more patients at the office. The EMR will decrease the number of those visits by slowing you down, and will negatively impact FFS (at least initially).<br /><br />If a physician sees 80 patients per day, and works an 8 hour day (9 hours, 1 hour lunch), then that is 10 patients per hour, including charting--6 minutes per patient. The average length of consultation in family practice varies, but is generally 10 to 15 minutes of direct contact; 17 minutes here: Annals of Family Medicine 3:494-499 (2005). Average work week: 50 hrs (National Physician Survey 2004). The 80 patient per day physician exists, but is atypical and not representative of our profession. I can see 10 patients per hour when I work in our After Hours walk in Clinic and in no other setting. <br /><br />The efficiency within the EMR comes from being able to do more per visit, and to do more outside of visits (example, assigning tasks to staff such as calling patients to inform them of normal results). As well, I can see if there are additional future appointments as soon as I load the chart, and I address these at the current visit--therefore making the additional visit unnecessary. <br /><br />I am more efficient because I can do more per visit and I can do more outside of visits. This is related to the EMR (point of care reminders, alerts, electronic assignation of tasks). It decreases patient demand for visits while maintaining quality. If I was on FFS, then I would be getting paid less; being on capitation means that I am rewarded for this. Therefore, I can eliminate waiting times for my patients to see me (today it was zero days), or I can increase my roster size by taking on new patients. <br /><br />Neither FFS nor capitation addresses quality of care.<br /><br />The EMR can make you more efficient in the alternative way I have described. However, this efficiency is rewarded only if a physician switches over to a capitated system of payment. I am not saying that FFS is a bad system, but I am saying that you get the system you plan for.<br /><br />If physicians become more efficient, then we can take on more patients in our practices. Whether the health care system can afford this under capitation is another question which I cannot answer.<br /><br />EMRs are immature, and the switch is in the early stages for most of us. I think we're still quite a long way from "type B" efficiency in most practices. You are seeing an early adopter at work.<br /><br />MichelleMichelle Greiverhttps://www.blogger.com/profile/15528486116262255346noreply@blogger.comtag:blogger.com,1999:blog-20382865.post-23726318637566295792010-01-05T13:19:47.486-05:002010-01-05T13:19:47.486-05:00Hi Dr. Greiver,
Many thanks for continuing to pub...Hi Dr. Greiver,<br /><br />Many thanks for continuing to publish your excellent blog. I think the metrics info on your practice is a great step forward to improving the quality of care for patients.<br /><br />The outstanding issue I see is the total number of encounters per year (knowing that you work part-time). I think one of the major problems with EMR in general is that it will slow most physicians down to the point where they either can't make enough money or the system will require more doctors enrolled in a capitation model like an FHT/FHO etc. I know of many FFS primary care physicians that see over 80 patients per day and some see more than 100 per day (20,000+ encounters per year). Could the Ontario healthcare system afford to have all 11,000 primary care physicians using EMR today?<br /><br />Will/can quality of care improvements necessarily reduce the total number of patient encounters to make up for the aforementioned slowdown most doctors find when using a comprehensive EMR system like your group?<br /><br />Your thoughts on this issue would be great.<br /><br />EGBAnonymousnoreply@blogger.com