Commentary on medical news by a practicing physician.

  • Epocrates MedSearch Drug Lookup


    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

    ''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
    -Robert Ehrlich, drug advertising executive.

    "Opinions are like sphincters, everyone has one." - Chris Rangel

    email: medpundit-at-ameritech.net

    or if that doesn't work try:


    Medpundit RSS

    Quirky Museums and Fun Stuff

    Who is medpundit?

    Tech Central Station Columns

    Book Reviews:
    Read the Review

    Read the Review

    Read the Review

    More Reviews

    Second Hand Book Reviews


    Medical Blogs


    DB's Medical Rants

    Family Medicine Notes

    Grunt Doc




    Code Blog: Tales of a Nurse

    Feet First

    Tales of Hoffman

    The Eyes Have It


    SOAP Notes


    Cut-to -Cure

    Black Triangle



    Kevin, M.D

    The Lingual Nerve

    Galen's Log



    Doctor Mental



    Finestkind Clinic and Fish Market

    The Examining Room of Dr. Charles

    Chronicles of a Medical Mad House



    Health Facts and Fears

    Health Policy Blogs

    The Health Care Blog

    HealthLawProf Blog

    Facts & Fears

    Personal Favorites

    The Glittering Eye

    Day by Day


    The Business Word Inc.

    Point of Law

    In the Pipeline


    Tim Blair

    Jane Galt

    The Truth Laid Bear

    Jim Miller

    No Watermelons Allowed

    Winds of Change

    Science Blog

    A Chequer-Board of Night and Days

    Arts & Letters Daily

    Tech Central Station





    The Skeptic's Dictionary

    Recommended Reading

    The Doctor Stories by William Carlos Williams

    Pox Americana: The Great Smallpox Epidemic of 1775-82 by Elizabeth Fenn

    Intoxicated by My Illness by Anatole Broyard

    Raising the Dead by Richard Selzer

    Autobiography of a Face by Lucy Grealy

    The Man Who Mistook His Wife for a Hat by Oliver Sacks

    The Sea and Poison by Shusaku Endo

    A Midwife's Tale by Laurel Thatcher Ulrich



    American Academy of Pediatrics

    General Health Info

    Travel Advice from the CDC

    NIH Medical Library Info



    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


    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  

    Post a Comment

    This page is powered by Blogger, the easy way to update your web site.

    Main Page


    Home   |   Archives

    Copyright 2006