Today was the day that I officially switch to EMR. I am definitely getting faster at entering clinical encounters, to the point that I may have tipped over to being faster on the computer. My staff is now entering all heights and weights in the EMR; I have figured out how to have the "vitals" template (which includes height, weight, BP, Heart rate, Peak Flow) pre-loaded into each clinical encounter, so accessing it from that area is a single click. Phone calls are recorded in the computer. I have been notified by one of the labs that they will now be sending me results electronically; however, that is not the lab that I use the most often, so electronic lab reporting is not happening yet.
We are all trying to figure out how to decrease paper as much as possible. The chart for the second patient I saw today could not be located; that is one thing that won't be happening any more.
I have more letter templates, such as a transfer of information request. I have the referral letter process down pat. I have now written over 100 prescriptions, and my "favourite drugs" list is getting to be very useful. It is interesting that the EMR software numbers my prescriptions sequentially, so I know how many scripts I write each week. I can see that I'll be able to search easily for drugs. I get a prescription profile each January from IMS, which is a company that buys information on physicians' prescriptions from pharmacies and resells this to pharmaceutical companies and others. Those IMS summaries never looked very accurate to me, but now, I'll know.
My staff has "read only" access to clinical data in the chart; a patient had lost a prescription and my secretary was able to access that for the pharmacist from the electronic chart. We are getting used to finding out where things are in the EMR.
I can see that I will need to start building templates for XR facilities that I use most often, so I can print XR requests from the computer. I am sure that most places will not mind if I don't use their forms--it is probably more important that the information is clear, complete and legible. My information and the patient's information will automatically be generated on the diagnostic imaging requisition, along with the CPP if needed. I'll get rid of all those paper pads.
I've been trying to figure out how to get information from my tablet as efficiently as from my Palm. The EMR does not have good clinical calculators or decision support (the only one I found is Framingham for heart disease prediction). I'll still need to use outside software for that. The PDA is really good for quick decision help (for example, Medrules) and quick calculations (like MedMath). I found something that I think will work for me at the CMA website, InfoRetriever. It is at www.cma.ca, click on the "clinical resources" tab, then "InfoPoems clinical tools" on the tab on the left, then "InfoRetriever". It is very good for decision help (for example, the sore throat score), but not very useful for calculations, like creatinine clearance, because chemistries are in mg/dl (US values) not umol/l, which is what we use in Canada. I can use the decision help program to look up things, but will have to enter the result manually into the EMR. I wonder if that kind of thing can be integrated in the EMR, so I can load the rule straight into the patient record.
All in all, not a bad start.