10.26.06

I’m back

Posted in General at 5:54 am by Administrator

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03.05.06

EMRs In The Trenches

Posted in General at 5:27 am by Administrator

Not surprizingly there are many opinions from many physicians, regarding how one should implement an EMR. Our own American Academy of Pediatrics (AAP) has its own suggestions regarding the process, as do I. In my opinion (this is my blog, after all), the key to implementation is just keep the process very simple. This is particularly important for the small or medium size practice. Implementing an EMR need not be a life changing experience,  or so expensive that it impacts significantly on your practice overhead, or something that you may regret in the future. Keep in mind that EMRs like insurance contracts will change over time, and the EMR you start with today, may not be the EMR you will be using several years from now. This should not (repeat not) disuade you from implementing an EMR now. There are two approaches to implementing an EMR, one commonly called “the big bang” approach where after weeks of preparation you “go live” with the EMR, vs a more conservative “incremental” approach, where you migrate over a period of time from your existing charting system.  I favor the latter approach.  This gives you and your staff time to train, learn and gradually transition to full EMR implementation and is only possible when you use your in EMR in tandem with an existing paper chart as I’ve long suggested (at least initially). Additionally you can work out any bugs or made modifications long before they become problematic. This KIS (Keep it Simple) approach works well and should help you avoid any major problems with your implementiation. 

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01.10.06

Consider the Inexpensive EMR!

Posted in General at 6:13 am by Administrator

There has been a considerable amount of cynicism expressed here and elsewhere regarding the adoption of an EMR by a small medical practice. Those who have started the process of investigating their options have learned that there are many vendors of EMRs, promises are many, and prices vary considerably. Even if you’ve done all your research, once you implement your chosen EMR, you may learn that the reality of the EMR differs from your expectations.

However…..

The true advantages of an EMR (expensive or inexpensive) is that you will (I repeat, will) practice better medicine.  Your notes will be legible, as will your prescriptions, and requisitions for X-rays and patient labs.  You will immediately reduce medical errors, and receive fewer calls from pharmacies and labs asking for clarification of your prescriptions or procedure requests.

In all likelihood you won’t make more money, but you may be more efficient.  If you have reasonable expectations you will be pleased with your decision.

Now, let’s help you decide.  What would you like, and how much will you spend?

As I have stated in the Electronic Pediatrician web site, I personally think the advantages of a “paperless” office are much overstated, particularly when you consider how much more work is required to scan documents and integrate these into EMRs. I prefer to keep my paper charts intact, but I use my Practical Medical Record, to print out legible notes, etc. (the PMR does support a “paperless” office, for those who insist upon this feature).I don’t waste my staff’s time scanning the hundreds of pages of documents that come in every day – we have much more important things to do.

Investigate “basic” EMRs  -  I would include SOAP Notes, Amazing Charts, and my own Practical Medical Record among these.    Ease of use, and low cost characterize these programs.  You can look at all the demos in the world, but until you actually use an EMR, you don’t know how good or bad it is. Other suggestions - Visit practices that have implemented an EMR successfully. Consider a single workstation, initially.

When I designed the Practical Medical Record for my pediatric practice, I had several thoughts in mind.  It had to be easy to use, with a simple navigation interface, and require few clicks to achieve results. It had to have the ability to configured easily by the user, to turn on or off features that some may like, while others may not. I needed to easily generate the paper forms (prescriptions, health forms, doctor’s notes) that I needed to provide patients with every day. Most importantly it could not slow me down, and I needed to be able to see the same number of patients post EMR implementation as I did before EMR implementation. After achieving this, I began to add intelligence to the program by providing quick dialog screens to assist nurses in interviewing patients, or determining which vaccines are needed. I then integrated referral forms, hospital admission forms into the program, again to facilitate my practices interactions with the analog (that is, paper based world). So in summary. Have reasonable expections, do a reasonable amount of investigation, but don’t delay implementing an EMR. Once you make the switch it will be difficult to go back. 

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01.06.06

Update…

Posted in General at 6:55 am by Administrator

As I start my attempts to increase traffic to the web site I discovered that according to Yahoo and Google there are now five times as many searches for “EMR” compared to “EHR”.  This may indicate that the medical community likes the term EMR better than EHR or the latter just hasn’t caught on yet, despite its penetration into the medical literature.  Perhaps, as I have said in the blog, physicians consider that an EMR is the actual tool that will generate an EHR.

Also, according to the Medical Group Management Association survey referenced in a previous blog, the average cost of EMR implementation is $33K per physician with maintenance costs of $1500 per physician per month. The survey indicates that this translates into a 10% reduction of take home pay each year for most primary care practices. They also indicated that a substantial fraction of practices also experience a reduction in practice productivity during implementation of 10 to 15 % for at least several months. That last interesting bit of info:  the actual cost of implementation  were higher than they had expected with cost overruns averaging about 25% over the vendors’ estimates.

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12.30.05

Is It EHR or EMR?

Posted in General at 6:46 am by Administrator

The transition of paper based medical charting to electronic format has long been a vision of the medical community. A decade ago the acronym CPR (“computer based medical record”) was in vogue, and 2 years ago, the term acronym EMR (“electronic medical record”) was typically used.  Currently these seems to be a transition to EHR (“electronic healthcare record”) and the term is now the most frequently used in the medical and lay literature, and may likely supplant the EMR acronym.  Many have made distinctions between all the acronyms, and many “experts” (described by their own acronyms like HIMMSS, ASTM, AAFP, AAP, IOM, etc.) have expressed their own definitions.

The scheme I like was presented in an article from 2003 that appeared in Healthcare Infomatics Online:

(http://www.healthcareinformatics.com/issues/2003/05_03/cover_ehr.htm)

ELECTRONIC PATIENT CARE TERMS AND THE VISIONS THEY REPRESENT

EHR (electronic health record) Generic term for all electronic patient care systems

CPR (computer-based patient record) Lifetime patient record that includes all information from all specialties (even dentist, psychiatrist) and requires full interoperability (potentially internationally); unlikely to be achieved in foreseeable future

PCR (patient-carried record) All information contained on a token or card that patient carries; most pilots and demonstration projects have been discontinued

CMR (computerized medical record) Any document imaging-based system

EPR (electronic patient record) Similar to CPR but not necessarily containing a lifetime record and not including dental, behavioral, or alternative care; focuses on relevant information

EMR (electronic medical record) Electronic record with full interoperability within an enterprise (hospital, clinic, practice)

DMR (digital medical record) Web-based patient record using “pull” technology (minimum of messages)

PMRI (patient medical record information) Used in Department of Health and Human Services/National Committee on Vital and Health Statistics language

PHR (personal health record) Managed and controlled by patient; mostly Web-based

ICRS (integrated care record services) Term used in United Kingdom

This naming system may be somewhat outdated at this time, and the media and medical organizations will ultimately dictate the terms that are commonly used.  I personally like the term “medical” as it implies control by the “physician” (as opposed to insurance companies or government agencies, etc.)  Many view EMRs as the software tools that generate an EHR, and the EHR is a virtual record that dwells in cyperspace that can be recalled by any appropriately authorized individual or institution, much like credit and financial info is accessed now.  Clearly, especially while EMRs and EHRs are still in their infancy, and there is little or no interoperability between systems, there is little meaningful significance to any of these acronyms. Remember,  acronyms can be deceiving. To most, WNL means ‘within normal limits”, but for many it means “we never looked”!!!

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12.29.05

Welcome!

Posted in General at 12:20 am by Administrator

Why this blog?

I’ve been a pediatrician for over twenty years, the last 17 of which has been spent at Hampshire Pediatrics, a two pediatrician practice in Manchester, NH. Overall I enjoy my practice and my patients. Like many of my colleagues I continue to be frustrated by how complicated medical practice has become, how insurance companies continue to practice medicine without a license, and how many obstacles there are to providing our patients with the quality of care they deserve and we are capable of providing.

Since 1988, I’ve been a regular contributor to Contemporary Pediatrics (www.contpeds.com), writing about a variety of topics, which often includes office technologies, medical computing, the medical Internet, and sometimes Electronic Medical Records (EMRs). I have always thought that pediatricians in general non-academic practice had a unique perspective to share with each other, practicing as we do “in the trenches of pediatric care”.

Dabbling as I’ve done with EMRs, and unable to afford the EMRs I would like to use if money were no object, I developed my own EMR as a Filemaker Pro database over a period of years. The project has been an interesting one, and has given me an opportunity to take a real close look at office workflow, medical documentation, and the benefits as well as the downsides of EMRs. My “Practical Medical Record” EMR has evolved considerable over the course of years, and I continue to change it, improve it and add features as needs (and flaws) are identified. As the Practical Medical Record is now ready for “prime time” and may provide primary care pediatricians and other primary care providers with an alternative to the high end EMRs, at a very reasonable cost. Since there I very few forums that discuss EMRs, I thought I would start this blog to provide my perspectives on EMRs, medical technology, and medicine in general and invite others to join in the conversation. Thanks for stopping by, and please feel free to contribute.

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