Friday, August 04, 2006

The paperless office

I have now entered about 60% of all my CPPs in the EMR; about half of the paper charts for active patients have been scanned in and shredded. We have destroyed three shredders so far, and have now bought a better shredder.

My partner is away for the next two weeks. My secretary pulled a total of four paper charts for me for Tuesday, when I come back from the long weekend; none of the charts needed preparation such as stamping in the date or adding a lab requisition to the front. This was the least amount of work done here for chart pulls.

We have been talking about what to do with the gains in office efficiency once all the paper is gone. I think it is much more interesting for my staff to take on some clinical duties. My filing clerk is a trained lab technician, and does my blood work, pulmonary function tests and Electrocardiograms. Perhaps she can do my allergy injections, so those patients do not have to wait. She can also administer influenza vaccines or other vaccines if needed. I will have to find out what the requirements are.

I have also been thinking of buying an electronic blood pressure monitor, similar to what is used in the hospital. Coincidentally, my resident asked me to participate in a research project run by one of her colleagues: I am getting an electronic BP machine for a week, to find out what I think of it. I don't think it is better for me (compared to the standard mercury-based BP), but it will enable my staff to do BP for me as part of the intake for full check ups. Perhaps we can also do this for diabetic patients, and for hypertensives; I will have to figure out how.

I've been talking with my resident about doing electronic audits; I did an audit a couple of years ago for my diabetic patients, Chart Audits in my practice, and it would be interesting to find out what happened with blood pressures/sugars/cholesterols due to the introduction of the EMR. We had a look at my electronically generated list; she can get the vitals and lab work easily from the EMR. If the lab predates the EMR, the scanned chart is available on my office network. I think the electronic audit will take far less time than the paper-based audit; I wonder if results can be automatically entered in Excel, instead of transcribed.

I've received a note saying that I can log on to the electronic Child Health Network, which will give me access to the shared health record for children. It looks like this has information from hospitals and home care. Two more passwords for me. I also have remote access to my own hospital's database, which contains a partial electronic medical record (in-patient drugs, labs, diagnostic imaging, consult notes). I've used that sometimes to look up hospital results. I've also registered to access my lab results on-line, as a back-up measure if the EMR server fails (example, C.M.L. or MDS). There is also a site where all the pap smear results are kept, Cytobase . We seem to be building several pieces of an overall electronic health record, of which my EMR is part, but it still looks very disconnected. This is a bit like the early days of the internet; there were all these Bulletin Board Systems which were not connected to each other. You had to use separate phone numbers and passwords to log on to each one. Perhaps over time there will be bridges between all the systems, so that the data can follow the patient.

It is a start for an integrated health record, but there is still lots of work to be done.



Anonymous said...

Hi Michelle,

Nice work. You are making good progress and I believe that your journey towards an EMR based practice is a mirror of many others. Have a look at the BP Tru products by VCM Medtech. I am using one of their machines in my practice for Diabetic and Hypertensive patients. It provides an ability to take 6 consecutive readings and discards the first, averaging the last 5. I find it to be accurate and easy to use.

Keep up the good work.


Michelle Greiver said...

Thanks, Alan. My resident brought in the BP machine for us to try out, and it is the BP Tru. We've been trying it out for annual check ups, and it seems to be working out well; we've set it up to take a BP every 2 minutes. I think I'll buy one, although it is not cheap (about $1,000). Now we have to figure out how to mark diabetic/bp follow ups so my staff knows to take a BP (perhaps a different color on the scheduler).