Friday, September 21, 2007


It is difficult to do it all; I have some very valuable allies that have helped with EMR implementation in my group.

One of my secretaries is now working for my FHN as well, as our group admin. She has helped other offices to implement scanning: seven out of the nine of us are now scanning, and one is about to start. She regularly helps other staff with problems, and they are very comfortable contacting her, whereas contacting me would not be as easy for them.

One of my colleagues has stalled with her EMR implementation; she is in a hybrid office as I am, and so gets no help from her practice partner. She has not been able to start encounters, but would like to do so; however, she does not feel confident in her ability to enter data. I have been thinking about how to help, but it is a problem for me as I cannot spare the time to come to her practice and stay with her.

My new Practice Nurse is now getting allocated to various offices by the Family Health Team's Human Resources manager. At a recent FHT meeting, I introduced the RN to my colleague, and talked about having her come to the office. My colleague was very interested; the nurse felt that she would be able to help; the HR manager thought it was a good idea.

The nurse went to the other office yesterday. I lent her my extra laptop for the day, to make sure that there were enough PCs in that office. It helps if both the MD and the RN have access to the EMR at the same time, as each logs on personally, and permissions are different. The nurse can show the MD what she is doing, while the MD is logged on.

When she came back to drop off the laptop at the end of the day, my nurse told me that she had done several annual physicals, and had showed the physician how she entered the data in the preventive services template. She went in for some visits with the physician, and helped to enter things, and my colleague tried several encounters; she also tried a prescription. The nurse entered a diabetic flowsheet for a patient, and showed the physician how data from the Vitals template in the encounter, as well as lab data, flows automatically into the flowsheet. I really think it helps to have someone on-site; the nurse will continue to go there once a week.

While it is not always possible to have a RN to do this, often there are allies who can help. It is worthwhile thinking about some of the untapped resources present in our practices and communities.

I am now at 88% of paps, 89% of mammograms, and 100% of children's vaccinations for my preventive services. My colleagues are telling me that patients are calling in after having received the reminder letters. We are hitting some of the inevitable glitches, such as a patient who had a hysterectomy receiving a pap reminder letter; because we communicate, these problems are getting fixed (for example, telling the secretary how to tag that patient's chart as having had a hysterectomy, so they never get another letter again, and get labeled as ineligible for paps). I figure that we will have most of the problems with the initial mailing, and this will decrease with time; we have had surprisingly few issues.

The draft letters for the flu shot reminders are in, and everyone is deciding on how they will do their flu shots (clinic, RN times etc). We are now talking about holding a common clinic, since the data can be entered from any of our practice sites; I'm not sure there is enough time to organize this, but maybe next year. Our FHN admin has already organized the window envelopes and stamps, and she will mail the letters in October, as soon as we know the shots have arrived. We get a small amount of payment ($6.86) for organizing each reminder; our FHN admin has entered EMR billing lists for the flu shot reminders for each practice based on the mailing lists, and she will auto-bill after the mailing is done.


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