Friday, November 23, 2007

Adding a new physician

A colleague will be joining me in my practice on December 3rd. She has joined my Family Health Network (lots of paperwork), is coming on staff at my hospital (paperwork), will be using my EMR (paperwork) and will be receiving the OntarioMD subsidy (paperwork). I wonder if we could combine all this paper into one giant Sequoia. We also notified the labs so she can start receiving electronic labs from the outset.

I have been thinking about how to make it easier for her to start the EMR. It took a little while to register her properly on the system. I already set up her preferences for her, so that the system works from the beginning; these large systems are highly customizable, but the downside of that is that you have to set things up. When you first start, you don't know much about the options available, and it may not be intuitive. I have a good idea of how things run efficiently, so I put that in and she can always change it later. I've set up things in the EMR like lab favourites (1st prenatal etc) for quick lab ordering, quickfill for DI ordering, physiotherapy reqs, basic form letters, referrals etc. It takes a while to start a new physician, it is more complex than adding staff, a resident, or Allied Health; it is important to try to do it properly.

My secretaries know quite a bit about this, so they will help as well, and my nurse can assist.

She bought new machines, but the Vista system does not seem to see the Window XP machines on my network, so her computers can't access all my scanned documents. I will need to call my IT guy to have a look. In the meantime, I will lend her one of my machines so that things work from the beginning. There is a learning curve for the EMR, and it helps if everything is already set up and if you have some help and advice from the outset. I think one of the things that make the initial transition so hard is that you have to deal with everything at once: the hardware never works properly at first, and the software is terra incognita.

She has been using another software application in the practice she is leaving, and does not like it all that much. I'm not sure what the issues were, probably some combination of process problems and computer issues. I'd like to see if I can do a bit better, but I'm sure there will be glitches. I'm hoping to have everything running smoothly within 6 months, which I think is reasonable, and is certainly shorter than the 18 months that has been quoted for a transition from a full paper-based practice. It will be easier for the next generation of physicians.

I've just had a quick look at my overdue lab reqs: there are nine reports that were done but results were never received, from June to mid-November. We will have to call the lab and request copies. I cannot track paps that have not been received, because the lab will not accept electronically generated reqs (mine will only take their own proprietary form). I scanned the pap req in, and print it as needed, but that makes it non traceable. I have had a patient come back and ask for her pap result, which was missing. We called the lab and had them fax it; I can also look results up on line, but that doesn't help me if I don't know that the report is missing. Whether by fax or online, results do not flow into the EMR: we have to scan in.

I wonder why results go missing, and what can be done about it. We sometimes had paper lab reports delivered to us that belong to a different doctor, which explains missing labs on paper. It is more difficult for me to understand why electronic labs go missing; perhaps a technician miscodes the physician's name when the lab form is received. It is time for bar codes, which my system can do. There should be some way of having labs track missing results systematically, especially for the electronic labs.



Anonymous said...


The pap reqs are something we struggle with. I greated a Profile "pap" that puts in a diagnose,req and plan with a 2 button click. If I "fake print" this req then it creates a lab req that I can match when our cyto comes in. I then just send a regular pap req. It creates a little bit of work but does ensure that I can find missing paps.

Mike W

Michelle Greiver said...

Thanks, Mike. The plan is a great idea! You have to wonder why our labs won't accept a requisition that is computer generated (little risk of having the wrong label put in at the front), contains the information in a legible form, and can be tracked inside the EMR. The information is the same as what is on on their paper-based requisition.