Sunday, May 07, 2006

Reducing paper

I've found an area in the EMR where you can monitor your patients' preventive health automatically. It tracks things like pap smears or mammograms, and gives you a list of patients who are overdue. You can then write a letter to all patients who should have the service. I am still not sure how that works, but I'll have to find out.

I've now done about 100 Cumulative Patient Profiles; I've started to pull files from my cabinets alphabetically. I want to be completely switched over to the EMR by September, before I get busy with flu shot season. I've made plans to scan and transfer all my paper files to pdf format over the summer; I'll put those on a shared drive on my office network, so I can access them when I need to look up a record pre-dating the EMR. I'll get a reputable shredding company to take the paper files.

Nightingale is installing the upgraded software on our server Tuesday night. This includes the ability to do flow sheets integrated into the CPP. This will be very useful for things like INRs: the lab result will be placed right into the flow sheet, as will the dates and comments on dosage. I'll also program a flow sheet for diabetes management, with things like A1C, cholesterol profiles, weight, automatically updated on the flow sheet. We will also getting the ability to print lab requisitions from the EMR in about a month (since the government changed the lab reqs recently), which will help track missing results. Interestingly, the company also said that we will be able to generate bar codes, so perhaps that is coming for lab samples.

I still have to deal with paper forms. Some institutions are very wedded to their paper requisitions; I have to send a specific paper to order hemochromatosis genetic testing, or Tay-Sach's screening, or cardiac rehab. Government is very picky about forms as well (a form to order an eye exam, a form for coverage of certain drugs etc). These can't be printed from the EMR. What I've done is stamped the form with my name and address, and scanned them into a shared drive on my network. Now I no longer have to search for these forms, as they are alphabetically ordered, and accessible from my computer's desktop.

I've started faxing some simple referral letters (for example, dermatology) from the EMR. If the specialist accepts a fax and allows the patient to call directly, I "print to fax", and the fax gets sent straight from EMR. I'm hoping to be able to communicate electronically with specialist colleagues in the future. The referral process itself is needlessly complicated (each specialist sets their own rules on referral, there is limited to no information on waiting time per specialist, sometimes they do not see certain problems and we don't know that); perhaps, with better communication, this can be improved. There is no reason why a program can't keep track of each specialist's waiting time, and why a referral can't be made to a program instead of to a particular physician for most problems. There will be exceptions, but this would be much better than the current disjointed, fragmented, paper-based process. The program coordinator would make the appointment, and inform the patient of the address, time and date (perhaps electronically), with a copy sent to us (also electronically, straight to the EMR). Of course, this is a pipe dream.


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