Friday, July 28, 2006

At the four month mark

This was the first month during which I felt very comfortable using the EMR. There was no crisis this month, and computer use is now part of office routine. I am no longer going home later than usual.

I have entered initial prescriptions for almost all of my patients who are on multiple drugs; now it is a matter of renewing the drugs, which is a much faster process (tick the check-box, then print and sign). I have written over 1,000 individual scripts; writing a prescription is very easy now that my list of favourites is populated, as most new scripts auto-fill when I put in the first few letters of the drug.

We have remote access, which is extremely useful. I sometimes take charts home with me so I can enter CPPs later, which means I can have supper with my family. I now have 50% of all charts entered.

The old charts are getting scanned and shredded; large lacunae are appearing in my filing cabinets. Many charts are not getting pulled, because the paper chart no longer exists. I referred a patient recently, and had to add some radiology reports from her old chart; I loaded the pdf file on my Tablet from the hard drive at the front, picked the report that I wanted, printed it, and added it to the consultation request. This is working very well.

I go to the senior's clinic that I run offsite, and access the charts remotely; I usually carry a couple of charts back and forth with me because those patients see me at both the clinic and my office. Those old charts were scanned, and are now getting carried in my Tablet instead.

We are routinely using electronic messaging; the little scraps of paper with notes on them have disappeared. I sometimes use my "to do" list to leave a note for myself instead of using paper.

I found an area in the chart where you can put "follow-up" notes; I will sometimes use that instead of "Plan" in the clinical record. The Follow-up shows up in the summary when I open the chart, and reminds me to do something. For example, when I see a patient with diabetes, I will put a recurring Follow-up called "DM", which recurs every 3 months. This prompts me to look at their diabetic parameters, and is very useful for patients who have other conditions (such as schizophrenia); sometimes the diabetic follow-up gets lost in the middle of taking care of everything else. I also have a Hydrochlothiazide Follow-up, which reminds me to do a potassium after the first month of using this drug. I should program Follow-ups for other drugs, such as potassium and creatinine for ACEIs, so that I don't miss these things.

All the physicians in my group are using the EMR to various degrees, and we have signed off on the document letting OntarioMD know; this will mean that the monthly $600 subsidy will start.

The past month has been much easier than the initial transition period. Now it is a matter of putting in the rest of the CPPs, finishing the scanning, and learning more about the application. I should probably register myself for a booster session.


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