Saturday, June 23, 2007


Data entry for the preventive services is proceeding; we receive stacks of paper with the date of last pap/mammogram/flu shot from the Ministry of Health, reflecting billing done for those services. The students have now transferred most of this paper-based data to the EMR. We have hired a medical student to audit charts with missing billing data; he will actually be able to do this remotely for some of the data, using the EMR; that will be done from my office. Searching for lab data (paps) is pretty simple; searching for mammograms is more difficult as not all practices are scanning yet, so mammograms won't be in the electronic charts. He'll do a first audit in the EMR, and will then visit each practice to audit paper charts for the rest of the services. The EMR audit should be a lot faster than the paper chart audit, but it will be interesting to compare the two.

Once those audits are completed, we'll be ready to send out the first reminder letters. Each physician in my group will need to review and agree to the format of their letter, and then our FHN admin will send those out for the entire group. There is no doubt in my mind that EMR-enabled group functions are now a reality, because I see them happening in front of me. The Pay-for-Performance incentives for preventive services were crucial to get this going; I think P4P may well be an important aspect of EMR implementation.

Our FHN IT person came by my office last Thursday. I showed him how my scanned handouts and reqs work: they are on the external hard drive at the front, which is shared across my network (any of my office computers can access them). I gave him a copy of my scanned handout/req folder on CD ROM, to use for any one else in my group who wishes to have them. I also have pop-up messaging for instant communication in the office, and he had a look at that. He has already installed a much faster and larger hard drive at one of my colleague's office.

Four of the nine of us are now routinely scanning to the EMR; a fifth one is just starting. The handwriting template I installed remotely on my colleague's EMR is now working, and he's now using EMR for encounters.

I think we have progress!



Dr. David M. Kaplan said...

Michelle: Great news. As you know, our office of four using nightingale has been scanning all paper coming in for 2-4 years. Running the preventative care audit on the five parameters was very straightforward. We then set out letters with requestions attached for mammograms and FOBTs. We asked them to call in to book an appt for Paps (not to book a preventative healh exam.

This highlights that the need for actual 'annual physicals' is low; in truth, as we know it is a preventative & periodic health exam, doing a complete head-to-toe exam for the sake of doing it should not be an insured service..

Anonymous said...

Scanning has to be the biggest surprise to implementing an EMR. I don't think doctors realize how much paper comes into a practice that will need to be scanned.

Just make sure you are using a fax server to prevent printing and rescanning your faxes. As I said in another comment we're also working on digital signatures from patients so that then we just have to store a 1k data string as opposed to a 1MB scanned image. Sure saves on space and also saves on scanning time and errors.