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    Sunday, February 20, 2005

    EMR Saga Update: It's been three weeks now since I've adopted computerized medical records, and things are going smoother. The emotionally fragile staff member still comes close to tears from time to time, but this week it wasn't the computerized records that caused the tears to flow. It was a grouchy pharmacist. (WHY do you doctors' offices wait until 5PM to call in your prescriptions? Because our patients call at 4:30PM Friday crying they have no diabetes pills left!)

    Patient flow is back to pre-EMR levels and I'm running on time again. Documenting each visit takes less time than it did on paper charts, largely because I no longer have to write things twice. (Before the computer, I had to write many things twice - once on the prescription, lab request, or x-ray order form and again on the chart. Now, the order is generated from the computer note.)

    There are still some bugs. We haven't figured out an effecient way to do phone messages, for example. Or, rather, one that works well for everyone in the office. In the old system, the phone message would get written down a message slip, the staff would pull the chart from the chart racks, attach the message to the front, and put it in a pile next to my desk. I had four piles of charts. One for labs that needed addressed, one for documentation in progress, one for refill requests, and one for more urgent matters that needed called back sooner rather than later. A quick glance told me where things stood in each category. There are no piles or even categories in my electronic record. There's just one big, long "To Do" list with everything jumbled together.

    Messages on the "To Do" list can be labelled with four different priorities - low, medium, high, and stat. But in the bustle of the day, the staff forgets to assign a priority, which just jumbles everything up. There have been times when I've stumbled across a phone message at 10:30 or 11:00 at night while signing off and reviewing labs. I'm going to have to do some more staff education on the phone messages to get the system to work better.

    Some mistakes have been made with the computerized record, although few that couldn't also happen with the paper records. I haven't yet customized all of the text expanders that came with the program, so sometimes something unexpected appears in response to my typing. For example, a prescription for "Inderal LA" became "Inderal lately" because for some programmer "la" is short for "lately". That wouldn't happen with paper records, but opening the wrong chart for a patient visit can and has. And it happened with the computer last week, too, although I noticed it when the x-ray order came out of the printer with the wrong patient's name on it. That was fixable, but if I had already signd off on the encounter, it wouldn't have been.

    We've also had a problem with the creation of duplicate charts, largely due to staff inattention. They forget to check if a patient already has an electronic record and just go ahead and create a new one, or they try to get ahead of the next day's work by making up a batch of new charts with the demographic data entered and lose track of where they are on their list of patients. Luckily, these were also discovered before I signed off on any encounter, otherwise there would be great confusion when one patient visit gets put in one chart, and the next in another. It's just harder to catch that mistake on the computer than it is on paper. And, if discovered too late, impossible to fix.

    I'm still spending an extra one to two hours each day entering old patient history into the new electronic record, so I'm working harder and longer and expect to continue to do so for at least six months, since that's how often I see my stable complex patients. It is taking it's toll. I'm tired and distracted. I was half-way through dinner on Valentine's Day before I noticed the roses on the table. And it wasn't until February 16 that I noticed the envelope sitting in the number 14 slot of my bill organizer marked "Division of Unpayable Debt." I'm not if it was the touching note from my husband inside or the fact that it took me two days to notice it, but I cried.

    Nonetheless, I'm glad I made the move to electronic records. Patient visits are quicker from check-in to check-out for those who are already in the system. The data storage and retrieval capabilities are superior to paper. Test results and consultant letters get filed as soon as they come in instead of languishing in a "To Be Filed" folder. I have better and easier access to more information. Best of all, I have more flexibility when it comes to doing my paperwork. I can access my office computer from home on my laptop, which means I can go through test results and write consultant letters from the comfort of home at any time of day or night instead of schlepping into the office for the chart.

    Although we still have a few bugs to work out, I'm confident in the long-run this will turn out to be superior to our old paper ways. At least as long as some commission doesn't come along and tell me it isn't up to their arbitrary standards.

    posted by Sydney on 2/20/2005 07:45:00 AM 0 comments


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