Friday, December 07, 2007

Being irritated

We just got a new version of my EMR software. The colours are all different, the layout is somewhat different, my label machine didn't work and I get error messages with some of my bills. We got the new Ontario lab reqs, and I had to reprogram my saved lab favourites. I don't really like new software versions, it seems they never work quite right at the beginning and it takes a while before everything settles down again. Even giants like Microsoft can't quite get it right (Vista is very buggy).

I fixed the label machine; the billing error message is annoying but the bill goes through. I'm getting used to the new layout, and there have been some improvements, such as making the DI and lab areas of the charts easier to access without leaving the encounter. There have been some changes in the prescriptions that I haven't quite figured out yet; on the other hand, one of my FHN colleagues found that the EMR can now print a "non-prescription prescription" when drugs are stopped. That's useful, because I give this note to the patient so they know what has been stopped, and they can pass it on to their pharmacist.

I figure that if I'm irritated, I might as well be an oyster and see if I can make something out of it. I figured out a much faster way to get my lab and DI reqs into the record, which I hadn't seen before. I also followed up on my colleague's comment on the previous post, and now auto-load a pap requisition into the record, so that the pap can be tracked; while I was at it, I emailed the general manager of my lab company to ask him if it would be possible to send him my computer-generated req instead of the proprietary pap form. I sent him an example of a requisition, which is reproduced below. Maybe they'll agree this time.

Some of our lab processes are unnecessarily complicated; for example, a first prenatal exam involves generating a req for prenatal blood work, a second lab req with "IPS, part 1"(Integrated prenatal screening), along with a special Genetics form for the IPS; an Ultrasound req for Nuchal translucency; and a special public health lab form for HIV and other public health labs. That's five forms, plus the handout on IPS that I give patients.

I generated EMR form favourites for the two labs and the US, and they're now clicked into the encounter and batch printed. The special IPS form and the public health form (with my own information pre-entered, and all the public health blood tests pre-checked) are now together as a single file; Adobe Pro lets you put several pdf files together. I also include a letter of explanation that says: "book your ultrasound between 11 and 14 weeks; take the special IPS form, along with the lab requisition that says "IPS I" and the ultrasound requisition to the ultrasound place. The technologist will keep the ultrasound requisition, and write the results in the special IPS form. Take that form and the IPS I lab requisition to the lab on the same day; they will take your blood and keep both forms."

The single file with this letter, the IPS form and the Public Health lab form is then printed. That's one print for the EMR forms, and one print for the rest (instead of 6 load and prints--or having to look for a bunch of forms). Also, I'm much less likely to forget one of the forms, which I've done in the past.

This is my EMR pap req:

Cytopathology Requisition

Dr. Michelle Greiver

212, 5460 Yonge Street

North York, ON

M2N 6K7



(416) 222-3011


(416) 221-3097


Lab company



Patient: Dummy2, Patient

123 any street

Toronto, ON

M1M 2M2

Date of Birth:

Oct 1, 1947


(416) 222-2222

Date Created:

Dec 7, 2007

Priority: Routine

Tests requested:

Date of LMP:

December 2 2007



LMP 2 weeks ago. Cervix appears normal

Physician OHIP number:

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