Friday, September 29, 2006

Distributed information

My Tablet is back from the repair shop. The problem was that a small cable was getting caught when I twisted and closed the screen. They replaced it, but it took a whole week.

While the machine was getting its vasectomy reversal, I was using the backup laptop. What was interesting was that most of the functions that I use no longer reside inside my machine, so it wasn't as bad as I thought. Of course, the EMR isn't even in my office. My scanned old charts are on a networked external hard drive. The scanned paper requisitions (public health, Diabetes Education referral etc) are on the front machine. I still had some trouble, because my payroll program and Quicken (which I use for the practice's bookkeeping) are on the Tablet. These are backed up to a USB key, but I would have had to reinstall the programs on another PC. I guess the information is getting distributed to all kinds of different places; the laptops or PCs used to access the data do not actually hold that data inside. This is what they mean by "thin clients".

I received a report for someone who is another doctor's patient; her physician is part of my group. What I did is I scanned the report and uploaded it directly to the patient's chart. I sent a brief message so that the other office would be aware of what I did; I received a message from my colleague saying that the report was there, and it was no problem. I guess we can scan and upload from any office for any patient in this group.

This is interesting, because the government recently approved our application to become a "Family Health Team", or FHT. What that means is that we get some extra money to hire other health care workers, such as social workers or mental health workers, for our group. They will need to have remote access to the EMR as well; that way they can see and enter information directly into the patient's chart. We'll have to figure out what type of access each person can have. The location where the patient is seen no longer really matters, since access to the chart can be from anywhere.

I don't know yet how this will function, or who exactly we need to hire. I think it may help to have the occasional face to face team meetings, but I'm not sure how much of that we need. I find I work quite well with our home care coordinators or our Regional Geriatric Program, and contact is mostly over the phone. I have a feeling much of the communication will be over the internal EMR email, which is much more efficient. We'll probably get together if we decide to plan a new program, like an asthma clinic for patients identified as needing group education; otherwise, I don't really think I want more meetings, I have enough of those already. I think the key to this team approach will be the Distributed EMR.



Anonymous said...

I'm curious what you do with paper items such as medicolegal documents, Driver's Medical forms, letters from lawyers, etc. Do you fill them out on paper, scan them and then destroy the paper copy? Are they archived with your "old charts" on the networked hard drive or are they put into the current electronic chart?

Michelle Greiver said...

If a paper form needs to be completed, I will hand-write on it. The filled out form is then scanned to the patient's chart on the EMR, and the original is sent on to whoever has requested it. All incoming letters are scanned to the EMR.

I do not scan any new incoming document (including lawyer's letters) to the "old charts" on the networked hard drive, except for charts from new patients transferring to my practice. The old chart coming in from their previous family physician is the same as the old paper chart from my practice; it gets scanned to the networked hard drive.

If, in the future, I have to deal with some enormous 1,000 page medico-legal file due to complicated litigation, I may scan this to the network HD. Loading a large pdf file from the EMR will take too long, and the medicolegal file requires storage more than anything else.