Tuesday, May 27, 2008

Generating new ideas

I am sometimes asked about how I think of new things. The EMR is a powerful driver for new processes, because if you do things the old (paper-based) way, it does not work very well.

Very few things are completely new and world-changing like Google; my new ideas are small re-combinations of older things. This ability to figure out things is very human; machines certainly can't do this, and most animals probably don't either--at least my cat does not appear to.

Usually, I start with something that bothers me. For example, printing something and then re-digitizing it so it can be faxed seems silly; how do I fax directly from my Tablet? I don't have a fax server, and installing one does not seem practical. I can email; perhaps there is a way to combine email and fax.

The next step is to google "internet fax", and many sites pop up. Wikipedia gives me a quick run-down of how it works, and it seems reasonable. I give it a try, and it works.

I now have to figure out how to collate documents: many of my faxes consist of several documents (a consult letter, labs, scanned diagnostic images). I have to put all these into a single file, so I can email it to fax; if I don't do that, I have to save all the files to desktop, then attach a whole bunch of documents to the email-fax. That is too labour-intensive, and won't work.

When I write a consult letter, I sign it on the Tablet, then I print it. I have Adobe Pro; I can print it to Adobe and it saves it exacly, including my signature. I look at the Help in Adobe, and it tells me that I can create a document from multiple files; that seems pretty easy to do. I open three files, and try it, and it saves it as a single document. That works, and it is fast.

On top of the document, there is an email icon. I click that, my email program loads and I enter the fax. It works and is faster than printing and putting the letter at the front with a sticky.

Now I have a bunch of fax numbers saved in my address book. Sending a fax is now the same as sending an email. I still put long, complex faxes at the front, but most of the smaller notes go straight out from my Tablet.

That is how I do new things; it consists of figuring out what the issues are, trying things in small incremental steps, and solving problems along the way. Being curious and persistent helps.

If you like trying new things, the EMR is a gold mine for this, because it is early in its life-cycle. Bonus for innovators. If you prefer to let someone else start new things, but are open to trying them out for yourself, there are now enough innovations that you can help yourself from the menu. The on-line helpgroups for your EMR are a good place to look; provincial organizations like our EMR Advisor in Ontario also have good suggestions.

As another example, I am trying out new templates to help me with the clinical management of various conditions. At our recent Practice Based Small Group educational meeting, the module suggested a 3 question screener for suspected dementia. It seemed like a good idea, and you can see the resulting template at the top. I put a drawing area in the template, and the patient can draw the clock directly in the Tablet. It is saved as part of the record. I put this template in our Enterprise section, so it is available to everyone in my FHN.
The ability to try new things is a real EMR asset; the speed of communication also allows for a potentially very rapid spread of new ideas. I kind of like that.


Ian Furst said...

Hey Michelle, off topic here but our EMR is revamping the notes section. How is your EMR's notes section powered? Word based, Adobe, I see you've got a form with free form text allow in the mini-mental. Thanks Ian.

Michelle Greiver said...

Hi Ian

The EMR notes are a combination of text/templates/databases. They are actually much more complex than what you would do in Word.

The "subjective/objective" is a combination of text (I type, some people dictate, I also have pre-set phrases) and templates.

I program the templates using checkboxes, drop down lists, text boxes, drawing areas, vitals, tables etc.

The assessments (or diagnoses) are coded from a database, in my case in ICD9. The ICD code goes straight into the OHIP bill.

The medications are coded from a database; the database picks up allergies and interactions.

I can add lab or DI requisitions, many of which are pre-programmed (example, full check up diabetic). I can also add Consultation requests.

If I access an on-line resource during the encounter, this is stamped into the record.

At the end, I use either Recall (which also goes into my Summary and is tracked) or Plan, which is only in the encounter.

I actually used the new dementia screener template today with a patient, for the first time. I put the tablet down on the desk, and she drew a clock on it. It works.