Monday, September 17, 2007

Planning an office layout for EMR

I am currently finalizing the layout for my new office. This will have 3 physicians, at least one family medicine resident, one RN, and one Allied Health Professional. The office is 1,900 sq feet.

I have been thinking about what to change. The exam rooms are 8 x 10 ft, and really do not need much modification. I will have 8 exam rooms (2 per physician, 1 for the RN, 1 for the AHP). I don't know if my new partners will prefer wired or wireless; if they prefer wired, then they will need 1 printer in each room, along with a computer stand (or they can just put the monitor on the desk table). If they prefer wireless, then they just need a stand for the printer.

I will put network "drops" (the RJ45 plugs) in each room, so there will always be a choice. If wireless, then the printers plug into the RJ 45s; this is my current configuration.

I have chosen a common consult room; I think it is very important to be able to talk to each other, especially as the new physicians start practice and EMR. I asked my nurse if she would prefer to have a consult/exam room, or would she want to sit in the common consult room: she definitely prefers to sit with us. I will also have a space for the resident in the common consult room.

When planning a new office, I think it is good to consider workflow issues, as well as people issues such as how you communicate and work with each other. EMR impacts those.

The biggest change will be at the front office. There are no charts, so the front reception area can be a lot smaller. However, my staff does more callbacks, and they need space which is more private than the open reception area. I am planning a separate staff room; we can have lunch there, but it will also have a workstation for callbacks and administrative functions that do not require a secretary to be at the front (example, uploading bills, managing our preventive services etc). I am considering buying a second scanner, so there will be two places to scan: one at the front reception, and one in the back staff room. I will still have two desktop PCs at the front.

I went to the Canada Health InfoWay Peer to Peer meeting last Saturday. I met my colleague, Dr Brookstone, who reports what happened at that meeting , along with several physicians who had been email only until now. It was good to see others who are very passionate about this subject; sometimes you do feel as if you are a voice in the wilderness, although it is getting to be less so. Our provincial bodies (in Ontario, OntarioMD) will work on figuring out how we can help others; I think this will likely mean a contact from one of us when another physician is strongly considering EMR and wishes to talk to a peer (perhaps a site visit, or a phone call to talk about the specifics of deciding to implement EMR), as well as practical help with the early implementation glitches (this worked in my practice, this didn't, here are a couple of things to try).

One of the pharmacists at the meeting told me that signing prescriptions on my Tablet is now acceptable to the College of Pharmacists; I'm going to try that again. The College states that "For a written prescription, the physician's unique signature is required to provide the authorization." The Tablet signature fulfills that criterion.



Anonymous said...

I sincerely hope that you consult with an IT professional before your offer wireless communications within your new office. It takes a lot of expensive equipment to properly secure the privacy of your patients on a wireless system.

Michelle Greiver said...

We will certainly do that. I had the set-up in my current office done professionally, and will do the same in the next office. Because the office is so large (5 practices, all the Family Health Team's admin offices, offices for the Allied Health Professionals) we will benefit from economies of scale. I do not agree with your statement that the equipment is expensive.