The 4 Keys To Understanding EMR

There are 4 critical themes that underlie effective EMR use, regardless of your hardware, software, or practice setup.

Understand them well, and you will save heaps of time, protect yourself better medico-legally, and use your EMR to its fullest — to the benefit of yourself, your practice, and most importantly, your patients.

Ignore them, and…well, you’ll be reading this article again!

1. EMR’s Never Sleep

…Or get tired, or frustrated, or hungry. Unlike humans, they won’t drop the ball because they got distracted. Can you think of times when a note went unfinished, or you forgot which side the injury was on, because you were fried, or rushed, or tired? EMR’s won’t forget, and can be programmed to not let you forget, either.

EMR’s routinely keep track of important health maintenance data, and can alert you when a patient is due for something critical. Can’t this be done with paper charts? Sure - but only if you take the time to look.

The difference with EMR: the system reminds YOU. This is a prime example of the proper use of technology: using tireless machines to bolster tired humans. So you “remember” to order a patient’s overdue colonoscopy, when he comes in for a sprained ankle. Even if you’re too busy to check about his colon status, or staying focused on his leg.

2. The Most Expensive Cookbook You’ll Ever Own

Cookbooks lay out recipes you use time and time again: every time you make an apple pie, you use this much flour, plus this much sugar, mixed together in such and such an order. A lot of the repetition in medicine can be handled by your EMR in the same way.

• Do you instruct patients to follow-up if they’re not symptom-free within X days? Or to make an appointment annually for a physical, to screen for potentially life-threatening conditions? Assign keystroke macros to instructions like these, and insert the text into your progress notes — with one click. This 1) saves minutes per patient, and 2) explicitly documents your conscientiousness, bulletproofing you medico-legally.
• Do you perform your standard exams the same way, in the same sequence? (I hope so.) Do only a few of the details vary? EMR’s can remember the language you use for your normals, and autopopulate the entire exam as normal with one mouse click, so you can just update the specific variable fields.

Boilerplates save a lot of time, without sacrificing depth of documentation.

3. A Snip Here And There = Going Home Earlier

This is more of a workflow observation than a purely EMR one, but EMR magnifies the benefits: If you can shave off 5 seconds on each phone call, 20 seconds on each result notification, three minutes at the end of each visit, and 5 minutes on each prescription refill, your 20-patient day et al will end hours earlier than before. Small amounts of time saved each time you open a chart or see a patient add up tremendously.

An in-house review of EMR users shows a classic bell-shaped curve: most users ultimately work as fast as they did pre-EMR, some slow down, and some do much better than before. My own average patients-per-day went up from about 16-18 to 20-24, with better documentation and patient care.

How?

• Maybe you can write faster than you type, but I can click faster than you can write. If you type slowly or with two fingers, handwriting is faster, no argument — but the fastest data entry by far is checking off boxes that insert whole reams of detailed text.
• Clicking defined data fields enables better coding. Not only is clicking faster, but EMR’s can keep track of the data items you select, then suggest the supported E/M level. Or advise you when you’re just one question and two clicks away from a higher deserved code.
• Certain tasks become instantaneous. For example, e-prescribing and integrated EMR’s plus EPM’s (what your front office uses) mean refills take seconds, instead of minutes: no more office time spent taking a call, finding the chart, delivering it to you, reviewing the relevant parts of the chart, then instructing your assistant to call the prescription to the pharmacy (and their holding for the pharmacist, etc.). That’s at least 5 minutes saved, conservatively, per each and every refill request.

4. This Isn’t Your Child’s Word Processor

“Why can’t my EMR change screens as fast as my home PC, and why can’t it be as easily personalized as my word processor or email?” This is the No. 1 refrain from new users — the corollary to “Where’s the nearest window I can hurl this $&%?# through!!!” If you could just modify the EMR to your individual practice style, it would get out of your way, instead of you redoing tasks to its specifications.

Then life would be grand, right?

For now, you’ll have to take my word on this: No.

I’ve seen an implementation that failed — ground to a halt, the group stopped using it and went back to paper — when the staff got a little too flamboyant with the mods. EMR’s can do an awful lot of nifty stuff, but they can’t do everything, and super customization is one of them.

I’ll explore this — and many of these topics — in future posts. But the sobering reality is that EMR’s are about the most complex software you are likely to use on any kind of regular basis, with data fields and warning triggers linked backwards and forwards over applications that fax, e-prescribe, word process, graph, spreadsheet analyze, search & sort, and manage databases, simultaneously, and over thousands of patients over multiple users.

You’re engaging the services of The Great Wallendas and their 7-man pyramid, times thousands, cross-linked. Adjusting a pinky here and a foot there is a prescription for, shall we say, “system problems,” if not done thoughtfully.

Technology should conform to you, but it never entirely does — for some very respectable reasons. This blog will show you how to strike that happy medium: carefully customizing your EMR to you + respecting its intricacies = you, your patients, your staff, and your IT people being H-A-P-P-Y.