Friday, September 25, 2009

Melissa Young, MD: The Search for the Perfect EMR

OK, I know and you know there’s no such thing as the perfect EMR. But then again, there are EMRs that just don’t make getting an EMR worth the expense, effort, and loss of hair and sleep. On the other hand, I truly believe that finding an EMR that works for you and your practice can make you more efficient and can help you provide better care.

At least, I sure hope so. Just the thought of not having to thumb through 20 pages of paper to find the original sheet that had the patient’s past medical history, and of not having to rewrite their 20 meds down on a progress note, and of not having to hand write prescriptions for said meds makes me want to do the EMR happy dance.
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But although it was easy enough to decide that I wanted an EMR, it was much harder to choose the “right” one. My old practice had tried two, and had hated two. Part of the problem was the implementation. The other part was the EMRs themselves. As far as implementation, the physicians and nurse practitioners were asked to start entering progress notes in the EMRs without the benefit of being able to use the prescription modules or the filing modules.

As I see it, the attractive parts of having an EMR are the ability to print or fax prescriptions or to e-prescribe, and to file labs and other data into the system. Let’s face it, when you’ve written your notes the same way for five, 10, or 15 years, learning to enter data in a computer is a challenge. So to do that, and then still have to write prescriptions, fill out lab slips and billing slips, and hunt around the paper chart for information, really made this more of a chore than an advancement.

As far as the EMRs themselves, they just weren’t built for subspecialists. The history data points, the templates, were really geared towards primary-care physicians, or other specialties where patients come in with a particular somatic complaint, specifically pain. Location, radiation, onset, precipitating and alleviating factors just don’t work when the patient is coming in for a consultation for a Graves’ disease or an adrenal incidentaloma. And if the history and physical exam questions (and their possible answers) have to be the same for every provider in the practice…well, you can imagine how long and animated the discussions got.

Once again, I did my research. I looked at reviews of the various EMRs. On the AAFP Web site, on Physicians Practice. I looked at which ones were most appropriate for a small practice. Which ones were highly rated by other docs for ease of use and which came from companies highly rated for customer service. Which ones were in a price range I could afford. I narrowed it down to four or five. Then I scheduled demos for each one. Most of the demos were done online, one was done in person. I had them walk me through a full patient visit, starting from scheduling the appointment, entering a history and physical, and billing.

I thought my head would explode. I downloaded an inexpensive EMR that seemed pretty easy to use, but it didn’t have a practice management system. After all the demos, I narrowed my choices down to two. I scheduled site visits for each one. I asked to go to endocrine practices because I wanted to see how it worked in a situation similar to mine.

That was a bit of a problem. There are so few endocrinologists, therefore, there are so few who use EMRs, so finding a practice within a reasonable distance who use the exact EMRs I want to look at was difficult. I had to drive about an hour each way to visit the practices.

What happened at each place deserves a post all its own.

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.

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