Tuesday, April 11, 2006

Unbound medicine

I've been wireless for two days now, and using the EMR with patients. I had a look at what my colleague, Dr. Brookstone, said about using the EMR in the examination room, and adopted the recommendations. The pamphlet that Dr. Brookstone's site links to is worth looking at.

I start the patient file in the EMR before I go in the room; that way I can say hello to my patient instead of fiddling with the computer. I keep the computer in Tablet mode , so that it looks like a clipboard, and it gets carried in that way together with the paper chart. Before EMR, I did not take very many notes during the encounter (other than numbers, such as blood pressure, because I was likely to forget those). After EMR, this has not changed. I figured out how to enter numbers quickly in the vital signs area using the tablet pen; this replicates writing the number in the chart. I've shown several patients their data on the EMR by picking the tablet up and holding it like a clipboard. My patient sits on the examining table, and we look at it together. This works. One of my patients had come in for an asthma exacerbation last week, and I entered her new peak flow yesterday, and showed the two readings to her as a graph; I think it helped her to see that. She's buying a peak flow meter.

I asked several patients what they thought of this, and had rather positive comments. When I did not ask, no patient commented on the computer being present. When I am not using the tablet in the exam room, it lies on my desk just like a chart would.

I sometimes convert it to laptop mode, when I need the keyboard. This is typically to enter medications; typing is faster than entering with the pen. I tell my patients that it will take a bit longer than usual for me to write the script, as I am learning to use the new system. I expect that doing refills will be faster with pen entry, since you just need to click on the drug's checkbox and hit the "refill" button. I also use the laptop mode to quickly look up handouts and print them.

We used the scanner for the first time yesterday, and got stuck. We had forgotten one of the steps. Another call to the helpdesk; nothing ever works perfectly the first time, and you have to expect glitches. Today, it was no problem. We talked about when to scan, and decided that my filing clerk would take care of this. It is hard for a medical secretary to scan and upload in the middle of phone calls and greeting patients. We made an inbox where all the documents to be scanned and shredded are placed, to be done when the clerk comes in. The faxes are all coming in electronically as well; my clerk will also manage this: some will be printed (for my partner), some deleted (junk faxes), and some uploaded to the patient file.

When my IT trainer was in on Friday, I gave him my home laptop to configure for my office system. I was worried about dropping and breaking the Tablet, and being stuck without a computer. I bought a laptop lock, and am leaving the laptop turned on, beside the vaccine fridge. Now my staff have an extra data entry area, and I can unhook the laptop and use it in case I drop the Tablet. I also have medical students in from time to time, and that is going to be their computer.

I started using the EMR without patients for a week and a half, because my wireless was not set up. By the time I took it in the exam room, I was familiar with basic navigation, and had less problems with finding my way around while trying to listen to patients. This was due to serendipity, but it is not a bad way to do it. You have to be comfortable with excusing yourself from the room to load the encounter and write prescriptions, for a week or two.


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