In this neck of the woods, there’s a goodly number of folks who’ve taken the plunge, and adopted an EMR.
Cold sweats, galore.
With that in mind, here are some thoughts from a fellow user who’s been there and done that, to remind you that you can, too!
Old Charts Are Old Hat
Remember that scanning and abstracting is a temporary fix.
This is pretty key, since it’s easy to get bent out of shape over the old paper chart contents. Many new EMR users have a Linus-like fixation on their paper charts as security blankets, or the scanned and hopefully abstracted version thereof. Totally natural, since the early go-live days feel like flying without a net — but it’s ultimately a short-lived, transitional state.
Within one to two years (which can seem an eternity away when you start), you will no longer be digging even digitally into the “old chart,” since your EMR by that point will be the old chart. And finding info in your EMR should be infinitely easier and quicker than flipping through scanned images of paper documents.
That’s why it’s important at the beginning, to have your scanned info be categorized for relatively quick access, either by filing them in obvious categories like LABS, IMAGING, EKG, and CONSULT NOTES, or abstracting whenever possible (summarizing paper chart data in brief entries into the EMR itself). Scanned images take time to load and display, and often can’t be flipped through rapidly. When you have to dig for info, you want to know approximately where to go looking, instead of “somewhere in that 67 page document file.”
Just remember – you won’t be relying too heavily on those scanned documents for long.
Getting Quick And Smooth, Baby
Next, there’s getting comfortable — and fast — with the system.
Most of this is sheer repetition, like the flying hands of ultrasound techs as they twiddle the trackball and tweak the sliders and knobs with one hand, direct the sono wand with the other, while looking at neither. Practice, practice, practice.
It’s important to avoid tripping yourself up, and one of the biggest hurdles is the “I must click every button and fill in every blank line” syndrome. Unless you were the original designer of the templates, doing so is very unlikely to resemble your old workflow, and you will lose valuable time filling out what feel like financial aid forms for every patient encounter.
Your biggest ally is your technical support. Good support will be always available to assist you, by analyzing your prior workflow and helping you transition to a new, EMR inclusive workflow. They can tell you — and reassure you — about what needs to be filled out, and what can be left alone. Often, they can show you much speedier ways of filling out standard history or exam items, than you painstakingly typing out every finding.
Remember — these systems were designed to be used in real-world patient care environments. The EMR vendors wouldn’t exist as viable businesses, if they required users to multiply their workloads by a factor of 5 at every turn. You have the option of documenting each pertinent positive and negative, one at a time, in as much detail as you desire — the system has to give you that drill-down capacity. But just as you’ve developed efficient ways of being speedy yet detailed over the years, so have the EMR developers.
It is an entirely attainable goal, documenting a patient encounter accurately and completely, so that the entire note and all actions related to it are done before you see your next patient. Ask your support folks to show you how, and with practice, the speed and ease will come.
“Is It Safe?”
Finally, there are Good Habits.
Good and Safe, from an EMR perspective, doesn’t just mean speedy and accurate, it also means medico-legally sound. That means taking advantage of the extraordinary power that an EMR gives you, that relying on your own fallible protoplasm alone cannot.
Workflow analysis from your tech support will again be key, here. Your EMR has the capacity to remember every data element, and to remind you when things were done, not done, or when they are due. It won’t forget something because it felt tired one day, or because it got distracted.
You can basically take advantage of your tireless digital servant in 2 ways: what I call automation with patient encounters, and automation by time frame.
Automation by encounter is you paying attention when the system tells you to do something during a patient encounter — whether that be during a patient visit, a phone call, or prescription refill request. An “encounter” occurs whenever YOU or an office staffer lay hands on the chart.
Most EMR’s can alert you when certain pre-defined criteria have been met. These are either preset by the manufacturer (e.g. your 50 y.o. female patient is now due for her mammogram), or defined by you with your tech support (I want the system to jog my mammogram memory with my 35 y.o. female patients). A Good Habit to get into is routinely paying attention to and acting upon these alerts, regardless of the reason for the encounter.
- Is a patient seeing you for a sprained ankle, but overdue for their mammogram? No harm at all in printing up the mammo order and gently reminding them as they limp to the check-out.
- Is the pharmacy calling for a refill on the patient’s nasal spray, and the system telling you he’s overdue for his annual physical? Why not remind the patient to schedule one, and document that you did so?
The law looks upon every contact you have with the chart as an opportunity to act on deficiencies that are documented there. Fair or not, you may as well take advantage of the EMR’s ability to remind you of the biggies, and act on them whenever the chance presents itself. Look at your system’s version of an Alerts page with every encounter, and don’t ignore little red flags when they pop up.
Automation by time frame requires a bit more work — the idea is to systematize a method of acting on those patients who rarely if ever contact your office. And who would therefore be missed if you relied on “capturing” them during an encounter that may never materialize.
Since EMR’s don’t ever forget, you should be able to periodically generate reports of patients who fit certain search criteria. Getting your system to spit out a list of all your female patients between 18 and 65 who haven’t had a Pap smear in the past 12 months should be easy. Or a list of all your patients who missed their follow-up appointments this last month.
Whatever criteria matter to you, you can have the system track patients down using them. Decide upon a limited, implementable set of sweep criteria (start with 3 to 5, not 38), and strain your practice periodically.
You’ll pick up more tidbits as you go along, especially if you participate in a local users group meeting or regular EMR Committee to finesse the system, and your own use of it. Start slow, don’t hesitate to ask for pointers, and get some good habits started at the outset.
And you’ll do fine.
