Entries Tagged 'NextGen' ↓

What would the perfect…or rather, a nicer EMR look like?

I take issue with that recent FPM opinion piece by Dr. Christine Sinsky, “e-Nirvana: Are We There, Yet?”

As an EMR consultant who works with both physicians and an MSO, I find it lopsided and unhelpful.

Yes, I’d like my EMR to be seamlessly integrated with my personal workflow, unobtrusive, and a snap to use. But as one of my junior high teachers used to say, Well, there are a lot of things I’d like in life. Simply “putting Google on the project,” as Dr. Sinsky suggested, might or might not take us closer to making the magical EMR a reality.

Google’s essentially unlimited financial and programming resources do tip the odds in favor of success. But so would putting the Almighty behind the project. And while I do pray daily, I believe there’s a certain due diligence in getting the apple down off the tree and into my mouth.

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Any New Year’s resolutions, yet?

We’ve got a good one floating around the office these days: becoming more adept with the EMR.

“For goodness sakes,” said our nurse practitioner after being shown a keystroke shortcut. “What a time saver!”

“THAT’S the kind of thing we need to share with each other — shortcuts and tips it’d take forever to find on our own.”

What a concept: taking advantage of community wisdom. Something you can’t get out of your system’s instruction manual.

Something only you and your fellow users can make happen, once you get some momentum going.

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There’s a fascinating article on the EMR and HIPAA blog that I couldn’t pass up.

It addresses one governmental (i.e. Medicare) solution to the traditionally low adoption rates of physicians of EMR’s: lower the upfront costs to essentially zero with the VistA system built by the Veterans Administration.

The clincher for me was the following observation:

While Medicare’s plan is to offer the software for free, one must ask what free is. Currently, free is software but not training, installation, and ongoing support.

My commented response, heavily informed by the collective wisdom garnered from the recent NextGen Users Group Meeting, is reproduced below:

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I’ve never read anything by Joseph Stalin, but I gather he’d be much in demand for implementing EMR’s. From the management side, not the physicians.’

Dr. Cephus Allin’s presentation today, which referenced the late Soviet dictator, was titled How To Go From Paper To An EMR. It totally rocked; I wish I’d attended his other session, Why Everyone Needs An EMR. But that’s what happens when you have awesome content hidden behind modest titles.

Major take home points:

• shunt work more efficiently away from physicians onto support staff when possible
• less MD time/task = more patients scheduled/day
• abstracting the chart is much more important than scanning it
• limit the abstracting to absolutely necessary items (like problem list w/ICD-9’s, allergies, meds)
• limit the scanning to 10 pages per physician pass, and 3 passes, max, before bye-bye chart (ekg, last CPE, critical study reports/consults)
• when staff are limited and already multitasked-out, extend the go-live timeline, and adopt more incrementally and slowly

And that, indubitably, there are practices that just ain’t suited for EMR.

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I’m here at the annual NextGen Users Group Meeting, in Orlando, FL. While I hope to get the skinny on making my group’s NextGen EMR sit up, beg, and perform like a lonely Australian Sheepdog, my main mission is more generalized: to learn how better to assist new MD’s in successfully adopting this, or any, EMR system.

And if South Orange County California is anything like the rest of America, that means focusing on small group practices of three or fewer physicians.

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Nobody wants to crash and burn their EMR.

It’s supposed to be pretty hard to do that, thanks to the built-in redundancy of most large scale systems. Your patient data isn’t going anywhere — in NextGen, for example, it’s backed up automatically on multiple servers. And while I’m more a fan of the nearly crashproof Unix-based operating system, 98% of the software industry finds Windows solid enough to design their EMR’s around. Short of a meteor strike or Armageddon, your EMR should function just fine, if used as designed.

What you do to it, however, is another matter entirely.

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This site is under construction, and will go live real soon.

Stay tuned, for tips on transitioning smoothly to an EMR, getting used to it, then making it work super efficiently for you and your patients.

I have 5 continuous years of experience with an EMR system — NextGen — which is now being used across all our medical group offices, and being adopted as the system of choice for the local primary care and specialty groups for our IPA.

But the insights I’ve gleaned apply to any EMR system, regardless of vendor. How you work on paper, switch to keyboards or tablets, and use or misuse your system — and how you can customize it to you, instead of you to it — are all independent of your system’s manufacturer, or your own specialty.

You can make choices that toughen your days (ever wanted to throw your computer out the window, or pound your mouse to get its attention?), or that make your practice flow as smooth as it did before — smoother, even, with better documentation, error checking, and justified upcoding. Even seeing more patients, faster and safer.

Click here for an example of my work, on my other medical blog and podcast.

Hope you find what comes useful.