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    Sunday, April 09, 2006

    Electronic Medical Record Pitfalls: Our office has had an electronic medical record now for 14 months, and we've (me and my staff) remain very happy with it. It's less work for the staff, but a little more work for me. It takes me longer to review outside reports than it did in the paper system, but the EMR makes up for that lost time in the better organization of information. It's easier to keep track of when someone last had a tetanus shot, or when someone needs a follow-up x-ray or other test.

    The hardest thing about going electronic is the implementation, as this article shows:

    It's often said that about half of all EHR installations fail. That may be true, "but it depends on how you define failure," says Ron Rosenberg, a consultant in Sausalito, CA. "Is it that the system is abandoned, or is it getting less than optimal use?"

    What Rosenberg sees the most is "partial implementation" resulting from the reluctance of some of the doctors in a practice to use the EHR. Even if only one physician in a 10-member group doesn't embrace the technology, he says, "they have to keep their paper charts. They lose all the efficiencies and effectiveness and the plusses that you get from an EHR."

    ...Frequently, physicians buy an EHR only to discover that they don't have the time, patience, or know-how to build templates that fit how they work. In many cases, this has doomed the EHR installation.

    ...A big factor in difficult EHR implementations is that practices don't figure out how their workflow will have to change when they introduce the EHR. "You have to redesign the practice to take advantage of the product," notes consultant Ron Sterling. "You have to rethink every process, from how a patient is dealt with at the appointment level to what happens when he checks in at the desk to the transcription process to how you manage your lab orders, surgical scheduling, and so on. Everything has to be redesigned, and you have to put in the correct investments in hardware and software to make sure everyone has access to it."


    I only had three people to deal with in implementing our electronic record - all of them employees who accepted that this was the way it was going to be, but the first two months of use were still extremely stressful - and painful. There were days when I thought they would all walk out and never come back. And our implementation went smoothly. There were no equipment breakdowns. There were no software problems or bugs. Our workflow didn't change that much. Patients checked in and checked out the same as before. Our electronic medical records is a simple one. It has no interfaces with outside programs - like labs and billing companies. It was just the stress of learning something new and breaking old habits.

    I had to cut back on the number of patient visits to give the staff (and myself) some breathing room for the learning curve. I did this by closing the practice to new patients. I didn't realize until the end of the fiscal year how costly that ended up being, even though I was feeling the pinch personally and professionally. But now I'm back up to my usual productivity levels, even though the staff still isn't as proficient in the use of the record as they could be. Like anyone, they're good at doing the things they do every day, but when it comes to finding something in the record or doing something they don't do routinely, they fall short. Still, as far as organizing, storing and accessing information the electronic record beats paper any day.
     

    posted by Sydney on 4/09/2006 09:17:00 AM 2 comments

    2 Comments:

    Do you have some 'best practices' that the medical profession follows for electronic medical records? I do not work in IT myself but am still aware of the need for regular, automated server backups, mirrored databases, offsite backup storage, etc. to ensure the integrity of your data.

    John France Reston, VA

    By Anonymous John France, at 4:12 PM  

    You touch on what I think is a key point when you say that your system doesn't have external interfaces. Multifunction systems are delightful, but they tend to add complexity with that functionality -- see, for example, the checkered history of Enterprise Resource Planning systems in the IT world. KISS still works.

    As for the prior poster's comment, he makes an excellent point. It's not just replacement of the physical media -- maintenance of the electronic system, unsexy as it may be, is crucial to success.

    By Blogger bill, at 9:32 PM  

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