Friday, April 28, 2006

Looking back at the first month

It is now four weeks since I switched over to EMR. For the past week, I have felt very comfortable using the Tablet routinely for everything; the EMR is now becoming an integrated part of my practice. What works for me is carrying the computer around in Tablet mode, and opening it as a laptop in the exam room. I like typing better than writing, and I don't see why I should store my bad handwriting in the computer. I type during part of the patient encounter as I am listening to my patients. Some of my clinical notes are starting to get completed during or right after the encounter, and I plan to get more of them done that way.

One of my colleagues said that his notes became much better once he switched to EMR: the usual scribbled information looked very scanty when typed, so notes became much more complete. Templates can also put a lot of information in the record very quickly.

What happens during the encounter is that I start typing in the clinical notes section. If there is a problem that needs a template (for example, a cold), then I load and fill the template. Other issues continue being written in the clinical notes section. It splits up the subjective/objective part into several sections, but seems to work.

I've made a template for my abdominal examination (Abdomen soft, bowel sounds normal, no hepato/splenomegaly, no masses, no tenderness). If there is something abnormal, I just uncheck the check box and write comments. Templates are really good for automating things that you do over and over again, and for documenting groups of normal findings.

The ability to look at sequential results for electronic labs is interesting. I had a patient with a mild anemia, who had another blood count done two weeks later. I clicked on the check box beside her hemoglobin, then clicked on the tab for "tabular results", and showed her that her hemoglobin was 107 two weeks ago, and 112 two days ago. This is much better than leafing through paper lab results. The software also does graphs; you click on the "graph" button. This is very useful for on-going conditions, such as A1C's for diabetics, or INRs.

I had a look at the scanner that I bought. It can scan documents into Adobe Acrobat pdf format. It also can do "duplex" scanning, which means that it takes a picture of the front and the back of a page at the same time. You can put 50 pages in the automatic document feeder, and it scans 25 pages a minute (or 50 pages if you do front and back at the same time). I tried that for some of my clinical notes, and the pictures are really clear and sharp. This is very interesting, because it means that archiving charts of my transferred or deceased patients is not going to be all that difficult or take all that long. I will get the clinical notes scanned in duplex, and the lab forms/consult letters in simplex (one side of the paper only). We'll call the files something like Doe, Jane clinical notes, and Doe, Jane labs; I'll hire a student in the summer to do this. I'll put the files on CD ROM disks, and keep two copies, one locked at the office, and one locked offsite. You can search for things easily within pdf documents, so this is useful for data retrieval. If this works well, then I'll scan and archive paper charts of active patients, once I've fully transferred to EMR. Maybe I can then sell my filing cabinets on eBay. I wonder what I'll do with all that freed office space.


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