Monday, October 12, 2009

Melissa Young, MD: The Search for the Perfect EMR, Part 3

The search is over.

Well, sort of. I mean, I’m done searching. But perfect? No. I wouldn’t say that. There are days I have plenty else to say (none of which can be published uncensored), but perfect? No.

Don’t get me wrong. I still think that among the different EMRs I looked at, I made the right choice with e-MDs. It was right for my budget — I wasn’t going to “settle” for one just because it was cheap (or free even) if it didn’t have the features I wanted, but I also didn’t have unlimited funds. (I did have other start-up expenses, you know, like exam tables and a new bathroom and such.) It had a decent number of endocrine templates, although I still made a lot of my own. It was fairly easy to make these templates, although there was a lot of trial and error. And my VAR has been pretty responsive to my cries for help (I’ve even got their cell phone numbers).

But perfect it is not.
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Going back to the templates — yes, easy enough to create, if you know what questions you usually ask, and what answers you expect, and just how you want that to look when it’s printed as a sentence. But it takes time. Time that most practicing physicians don’t have. I had the luxury of starting to create these while I was on “vacation” from my prior practice. And there are nuances you don’t expect until you try to create a note. Little things like where the period goes, and what conjunction to use, and do you let the user type in the answer or is it all multiple choice.

I have also discovered that a lot of labs and tests I order aren’t on existing templates, so I’ve had to add those on, too. I guess that’s the problem with being a specialist in a field where there are so few of us. I guess nobody else who seriously uses the system has bothered to add these things before.

And there are things you don’t discover until you’ve gone live with patients. Like there’s no good way to quickly enter the dozen of supplements they take when the patient brings a list of brand names but has no idea what the active ingredients are.

And there have been technical bumps in the road, too. I think I have to put my VAR’s tech support on speed dial. They usually address my issues quickly, and they do a lot remotely. I hate calling for help, but I know my limits. I’m a decent end user of technology, but I am not a tech person. So hallelujah for remote access.

Before you think that all I have are complaints, let me make this disclaimer: I am very critical of things. I think all doctors are, or should be. We are taught to look for what is wrong with things.

I believe in my EMR. I believe that once I have worked out the bugs that it will make my staff and me more efficient. It will certainly save me space that would be taken up by paper files. It saves my secretary from pulling a chart to put a lab result in it or to give to me if a patient calls with a question. From the comfort of her desk, she can put the patient on hold, call over her shoulder, “John wants to know if you said increase his basal rate to 1.0.” And I, in the middle of reviewing someone else’s labs (that have automatically been faxed into the EMR), can pull up my note on John and tell her to say, “Yes, that is precisely what I said.”

I hope to save on paper — both making me green and saving me green. No more printed faxes. No more cover sheets. No more print outs of lab results that just say “pending.” It will remind me, when I am overworked and the patients merge into one giant faceless patient, that it is time for Mrs. Smith’s DXA, that Bob needs a flu shot, and that Mr. Doe owes the practice $50 in no-show fees. (Hmm, perhaps a topic for another post.)

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.

1 comment:

  1. $50 No show Fee!!!???? OMG!!!!! You go girl!