Wednesday, June 06, 2007

EMR Enterprise: To Boldly Go.

The Enterprise function is now starting to pay dividends; I have been thinking about it for a while.

We have a FHN administrator, and an IT person for the group; there is now enough physician experience with the EMR in this group to fix most problems, and we have a central server in case we need access to different practices. You need all those pieces for things to happen.

Our administrator has started to make house calls to the different offices to see if she can troubleshoot and improve processes. She works part time at my office, and part time for the group; we discuss problems at lunch, so that helps us think about them. She took printouts of processes from my practice, to distribute them to my colleagues to use as they see fit. She spends a bit of time with staff in each practice, and works with them to see what can help.

For example, one practice is not using the scanner. They called the IT person, and it was properly connected to the PC before our admin came. However, software to scan to pdf files was missing; it came with the scanner, but was never installed. The IT person will install it, and the scanning process will be started. Our FHN admin also showed their staff person how to manage the rostering process on the computer, and how to use emessaging.

In another office, one of my colleagues would like to use the Tablet, but can't type. He asked the FHN admin if we could set up a handwriting program. I logged on to his practice remotely, and set up a template for him with vitals on top, and a drawing area for him to hand write on the bottom. His secretary called me, because the drawing area wasn't loading (it looks like an "x"). I know that this is because Java isn't installed on his machine, and I told his secretary that. She made a note; the IT person will be coming in a few days, and he'll install it, amongst other things.

We have hired students to go to each practice, and to enter all the rostering data. They are also updating the preventive services lists. Once this is finished, we can start mailing out reminder letters from a single location; the central mail-out will be ready for the next flu shot season, and we'll send out letters as a group. Each physician's letterhead will appear on top. I understand that the cost of doing this if you contract it out is $3000 per physician ($27,000 for the 9 of us per year). The cost to us of doing this in-house will be considerably less; in addition, we are getting a significant amount of help with the EMR for the funds. The $27,000 would be money well spent if we didn't have EMR, or couldn't organise ourselves; however, it does not make sense when compared to the cost of improving EMR processes. Spend money not on buying fish, but on learning how to fish.

I think that, once the EMR is going, it is very worthwhile to think of how to keep it moving forward. If there is no attention paid, some of us will likely abandon what we have already done; doing it half way is much tougher to sustain that just going back to paper--you don't know where things like your lab results are, your staff is still pulling lots of charts. There will likely be different ways of doing this for different groups. What I think will work in my group is:

1. a group administrator, to troubleshoot processes (preferably house calls at first)
2. a group IT person to troubleshoot IT hardware/non-EMR application software problems
3. a super-user physician as backup
4. remote access to the all the practices from a single log-on for group functions--the EMR enterprise part: one group, one server.

It may be easier to go forward in one big office, with all the physicians and staff located together. We don't have that in my group; like the majority of family physicians, we work in small, 1 or two physician practices. It is still possible to work as a group; I have outlined the steps we are now taking to do so.

I wonder if anyone would be interested in an "EMR implementation for Dummies" book.



Marc Morgenstern said...


I know this response to your blog is a bit after the fact (about 3 years) but I thought I'd give it a go.

I'm an independent consultant for the past two years, specializing in training and implementation of EMR systems. I'm truly amazed, considering the push by the Federal government here in the States (20 billion dollars reserved by the Obama administration for EMR implementation) to have every American's medical records online by 2014, there isn't a single book or educational guide written in clear, non-technical language for this purpose.

I was just thinking the other day how helpful it would be to have an "EMR for Dummies" book.

I'd be interested in hearing your ideas and thoughts concerning such a guide, as well as your experiences in implementing your own EMR system.

Michelle Greiver said...

I think it would be a good idea to put the whole thing into a "dummies" book. There are already good books on the subject, such as Nicola Shaw's "Computerization and going paperless in Canadian Primary Care". However, a very practical and straightforward manual would be helpful.