Online

Given a referral to a specialist, I wonder about seeing yet another physician.  My PCP is great; I trust that he’s sending me to a good doctor, but I’m still curious what to expect.  What does the person look like?  Which med school?  How old/experienced is the doctor?  Am I going to get lost trying to find the office?

Google can be great answering those questions.  It’s nice to type in the doctor’s name and find the practice’s website:  physician name, photo, CV, office hours, driving directions.  Everything I want to know is there.  I don’t have to interrupt the receptionist to get my answers.

When I was sent to an orthopedist, it was a bonus that the practice’s website was linked to their EMR.  Instead of phoning the office to set up an appointment and asking them to snail-mail me all the paperwork in advance, I was able to request an appointment online and fill-in-the-blanks electronically instead of filling out the paperwork longhand.  It was great!

At least it was great until I arrived for my appointment.  At check-in they confirmed everything I’d entered online, then handed me a ream of paperwork and explained that they were in the process of switching from paper charts to electronic, and needed everyone to fill in all the bubbles so that the information could be scanned into the computer.  When I pointed to her printouts and reminded her that my information was already in the new system, she took the Nazi defense (I’m just doing what I was told).

I spent 25 minutes filling out all the paperwork, repeating the information I’d entered online the week before and just confirmed at the check-in desk.

When I finally got to see the doctor, he had a paper chart in his hands, and I discovered that it was just the front office transitioning to EMR at that time.  Despite the doctor accusing me of being type-A, the visit went well.*  He did his exam, provided a treatment plan, and had me schedule a follow-up appointment.

When I returned eight weeks later, I was there the day the doctors went live with their new EMR.  Rather, they tried to go live.  Nobody was able to log in.  Lucky me.

My first appointment with him had gone well, but the second one was a disaster.  Even though I was the first appointment of the day, I sat in the waiting room an extra thirty minutes.  At 8:30 in the morning the doctor was already two patients behind, and finally decided to see patients whether the computer was working or not.  Unfortunately, the paper charts weren’t available.  The MA had jotted down some basic notes, but it was obvious that it didn’t give the doctor enough information to work with. With no paper chart and no EMR, the doctor walked into the room having only a vague idea who I was, why I was there, and what he was following up on.  He didn’t even know if the consultation note he’d been waiting for had arrived (it had, but I paid a whole lot of money to hear that he wouldn’t know what it said until they could get the computer working).

That’s a huge drawback to reliance on a computer.  When your system is down, does everything come to a grinding halt?

There needs to be a backup plan.  If the power is out, preventing computer access, it’s a problem.  If the software has a glitch, everyone’s stuck.  If patient records are half-way across the country and there’s a storm preventing internet access, patients might not get the treatment they need.  It doesn’t really matter what the excuse is.  If my doctor had stuck with paper charts, he would have had all the information he needed right at his fingertips.

The right software will make your job easier, not harder.   If it won’t easily give you the information you need when you need it, then it’s not the right software for you.  Computers are great tools, but they’re just tools.  Think of other tools.  I can grab a butter knife to tighten screws, but it’s easier (and more well done) to use a screwdriver.

Regardless of what business you’re in, smart shoppers don’t buy a database just so they can claim they’re computerized.  First figure out what information you need to keep track of and what you want to do with it, then find a program that meets the criteria.  That’s step one.

Step two is to invest in training.  You can figure out a $40 program from an instruction manual, but quality high-end programs should include training and transition assistance in the purchase contract.

Thorough training is essential.  So is a backup plan.  My orthopedist didn’t have either one.  I hate his EMR.

_________________________

*I’m not type-A; I’m just well organized.

First EMR

Saying “I hate EMRs” is like saying, “I hate seafood.”  There are just too many kinds to make sweeping generalizations.

I remember when I first heard the idea of using computers in a medical office.  Back in the late 70′s we had a VIC-20 at home*, and at school we had a TRS 80.  Personal computers were starting to be affordable by individuals (instead of those building-size contraptions only available to universities or large corporations).  The doctors for whom my mom worked were excited about the possibility of typing a patient’s symptoms into the computer and having a differential diagnosis print out.  Others scoffed at the notion, but nonetheless, people were starting to think that computers might be able to help in a medical setting.

Fast forward about twenty-five years.  The first time I saw a doctor using a computer for patient records was a good experience.  Instead of coming into the exam room with a paper chart, the Dr. Foote walked in with a laptop computer.  He loved his “new toy” as he called it.  The appointment went about the way a typical doctor’s appointment would go, but at the end, instead of writing notes in a paper chart, the doctor typed a few things into his computer.  On our way out, the receptionist handed us a typed prescription.  A fan of legibility, I thought that prescriptions printed from the computer were a fabulous idea.

Dr. Foote no longer carries a laptop into exam rooms.  He obviously reviews the patients’ charts before entering the exam rooms empty-handed.  He does whatever is needed, then returns to his desk to do his charting (computerized) before going on to the next patient.

From this patient’s perspective, it’s a process that works well.  It’s interesting that he does the same thing my family physicians does while using paper charts.

• they review past history before coming into the room
• they knows why I’m there
• they focus on talking to me, not the chart (whether computer or paper)

I wish my other doctors who use EMRs did it as efficiently.

In the future, I’ll be writing about some of my other exposures to computerized medical records.
Have you had positive experiences with EMR?

 

__________________
*upgraded to a Commodore 64 when I was in high school

One Chart

Computers are handy tools. 

With all the discussion of Electronic Medical Records (EMR) or Electronic Health Records (EHR - which autocorrect tries to change to HER), I don’t understand all the enthusiasm without any mention of how the drawbacks will be addressed.

There are, of course, some benefits.  The idea isn’t just to make it easier for individual doctors to keep track of data.  The idea is to share data.   Data such as lab results, MRI and x-ray images, and what prescriptions a person has filled are all objective.  Read the numbers, view the images, confirm that medications are being purchased – these things can help patients by making it easier for doctors to do their jobs.

What about sharing other information?  For years doctors have made observations and written corresponding notes about those observations.  Sometimes, though, doctors are wrong.  Being wrong in one paper chart in a single location isn’t desirable, but it isn’t earth shattering.  The doctor eventually (one would hope) finds the right solution, the correction is documented, and all is well.  OR perhaps the patient goes somewhere else, a different physician finds the solution, and the previous (wrong) doctor is never seen again. Maybe it doesn’t matter if wrong information is locked in a file cabinet somewhere in a dusty basement.

It’s very different when erroneous information is documented and then shared with others.  Wrong observations by one person can be digitally transmitted to a multitude of others, and that misinformation can haunt a patient to the grave.

EMRs mean that patients need to know exactly what their doctors are writing, and make sure that no errors are allowed to stand so that future providers aren’t influenced by bad information.