Friday, September 08, 2006

Having a resident in an EMR practice

After five months of use, the EMR is starting to pay significant dividends. We had no chart pulls this week; my practice is now paperless. All the old charts of active patients have been scanned and shredded, and we have now started scanning charts of inactive and transferred patients. I had to look at an old chart from home today, and just clicked on the file from the backup DVD of my practice; there it was. Amazing.

My desk was completely clear at the end of the week, despite having been away for two weeks, and I have no backlog. I feel as if I'm bragging!

My resident has now been given remote access to the EMR. I have taken on a few new patients recently; they have been specifically assigned to her, so she can build a "mini-practice" while working under supervision. She is only in my office one half day every week, so we were talking about how she can manage lab tests for her patients, because these are coming back before the week is up. We decided to do this: I will look at all results as they come in, and will deal with all urgent reports (such as INRs). She will log on remotely periodically. If results are abnormal, but not urgent, she will deal with them as she sees the result, and put a note in the EMR. She cannot sign off on lab reports, so I will always see the comments. We will use the internal messaging in the EMR to communicate about patients, because this is much more secure than email. This remote lab review would work very well for a family physician who has a very part-time practice. I have a "dummy patient"chart that my resident can use to practice, so she can see how templates and other more advanced aspect of the EMR work.

I printed and scanned a diabetic flow sheet so that you can see what it looks like in practice. Lab results and vitals go in automatically, and I enter the last four items manually; notes and meds are also for manual entry as required. Flow sheets are customizable, so you can put in the parameters you need. I have made flow sheets for diabetes, for asthma, for depression, for INR management, and for BP/wt loss. I'll probably make more; they are especially useful for chronic disease management.

No way I'd ever go back to paper.


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