Monday, May 29, 2006

At the two month mark

It has now been two months since I started using the EMR.

I am prescribing all drugs on the computer, and recording all encounters electronically. I now have electronic labs coming in regularly. I am writing all my consultation requests on the EMR. I am becoming increasingly comfortable and confident navigating the electronic chart.

The initial hardware hassles have been solved. My networked printers are working well, and my wireless network seems robust. I use the Tablet all the time, and turning the screen around as needed seems very natural. I put the Tablet in the docking station regularly at lunch to allow it to recharge; it has enough power to last a half day without problems, but not a whole day. I bought a laptop lock to attach the docking station to my desk, and can leave the Tablet securely docked if I go out for lunch.

I am using templates and flow sheets regularly, and have programmed several on my own. I am starting to use computerized forms for pap smears, and will try lab forms when they become available next month.

We are using clinical messaging regularly, and my staff is now very proficient at this. They are calling people regularly to inform them about some of the abnormal lab results. They are also becoming proficient at finding out where things are in the EMR. New office processes, such as scanning, are becoming smoother and more routine.

I have become more efficient at letting the helpdesk know when there is a problem. I have a "dummy patient" file to practice on. When there is a problem I can take a screen shot, using the "print screen" button; I copy this to a word file, and email helpdesk the picture. They can see what the issue is, and can often fix it without a phone call.

On the negative side, writing Cumulative Patient Profiles is not going as quickly as I would like. I find it tedious, and am probably avoiding doing it (especially when tired). I am now running a hybrid system, so I don't always know where things are (is that lab result in the EMR or the paper chart?). We leave the paper chart on a plastic sleeve on the exam room door when a patient is in, and I now sometimes forget to take it. I will have to figure out a way to indicate that a patient is in the room without the "chart on the door sign" once we are completely paperless.

Prescriptions continue to be an issue, as I am still getting random faxes from pharmacies letting me know that my Tablet signature is not acceptable. I have a stamp with my signature, and my staff stamps the script and faxes it back. This just seems silly.

My practice is diverging from my partner's; we will have to figure out what to do for holiday coverage. I think he is annoyed at times with all the disruption. We will be getting a family medicine resident in our practice for the first time, starting in July; it will be interesting for her to see both a paper and an EMR-based practice.

I am still going home later than usual. Since most patients do not have all their meds in the EMR yet, I am not yet reaping the benefits of rapid refills. Remote access through SSHA has not been established yet, although they are working on it. It will help once we have that.



Anonymous said...


Excellent, blow-by-blow description. Thanks for keeping us informed. Sounds like things are going well, but your partner is still skeptical? Any reason for that?


Michelle Greiver said...

Hi Karim

The main reason why he is so skeptical is the time commitment. He's pretty at much maximum capacity right now with clinical and hospital work. He goes home far too late most nights. I think he feels that adding the extra work stemming from EMR implementation would be too much for him.

Cost was not an issue, time was.

You do need to have some reserve capacity for this, both to learn to use it, and to transfer CPPs; far too many of us just do not have this.