Friday, October 27, 2006

Managing Flu shots with the EMR

Computers are good at making lists of things. As of October 1st, my EMR automatically generated a list of patients age 65 and over, since they are due for a flu shot. I have two lists
  1. a Report list, which shows how many patients I have that are 65 and over, how many received a flu shot, and the percentage who have been vaccinated
  2. a Letters to send list; this shows me the list of everyone who has not been vaccinated so I can generate a personalized letter for them. The list has buttons that you click on to generate letters
I wrote a letter inviting my patients to come in for the shot. We run two flu shot clinics in the evening, and the letter also includes the date and time for those. We bought window envelopes; the letters get folded so that the address shows in the window, so that we don't have to print labels.

When a patient gets a flu shot, I have a button that I click on in my Summary sheet. That removes the patient from the Letters to send list, and marks them as vaccinated in the report. Then I start the encounter; in it, I click on the drop down list for vaccines, and click on "influenza". I've preprogrammed information on lot number, expiry date, and route of administration, so that all gets automatically recorded. If the lot number changes, I can update the saved information.

If a patient gets a flu shot outside of my office, I just click on the button in my Summary sheet.

The vaccines are late this year. I've had to defer the clinics; we'll have one on November 27th, for high risk patients, and one on December 11th for everyone. I've posted this all over my office, and put it on my website. I've been telling people to look at my website to find out when the clinics are.

I was talking with my staff: after 6 months of use, we now have very little that is still managed outside of the EMR. All clinical notes, prescriptions, phone calls and inter-office messages are recorded in the EMR. Requisitions (DI and lab) are now generated in the EMR, with the exception of pap reqs (my lab has still not authorized this), public health reqs, and some specialized reqs (Diabetes education, MRIs). All letters and consult notes are in the EMR. Everything that comes in is scanned and then shredded.

I figured out how to upload faxes without printing and then scanning. What we do is view the fax, then click File, Print, Print to pdf. That transforms the fax into a nice, very legible pdf file, which is then saved to the "charts to upload" folder on the desktop. It is then uploaded to the patient chart along with the scanned files, which are saved into the same folder. I taught my scanning tech how to do it, and we have had no problems.

An 18 page old chart came by fax. Rather than printing it to paper, we saved it as a pdf file to the external hard drive where all my old charts are kept.

My friend at IBM told me to download a copy of Adobe Reader, and archive it. That way, I can make sure my files are readable in the future. I saved a copy to DVD.

My scanner sent a message that it needed a new pin roller; this is something that you replace after 100,000 pages. I guess we scanned that many. We're now scanning all the files of deceased patients. I think by the time this is over, I'll manage with a single filing shelf.

We had a meeting for my group of physicians last Tuesday. I think I've gone the furthest; most people have entered CPPs, some are prescribing in the EMR. We're going to go to Nightingale's computer training room at the end of November to share tips and tricks. We're starting to receive the montly EMR subsidy from OntarioMD, which is $600 per month for 3 years. I've also received a $2,500 bonus for entering over 600 CPPs.

My own family physician has retired. I will be going to one of the physicians in my group, for two reasons. That person is an excellent family doctor; as well, my chart will be on our server, so that I can access my own data. I've already entered my demographics, my CPP, and uploaded a couple of reports. I'm healthy now, so accessing my data is not that important; however, if I get sick, I want to know what is happening to me. I've made it so that I can.


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