EMR Purgatory – Not a Bad Place to Be

It’s been 21 months since I was forced to convert to an electronic medical record, and I have just now reached the point where I can say that the EMR has had a positive impact in my practice.

Converting to the EMR is not easy. This conversion is not like getting dunked in the river and seeing the light. It’s more like going through Dante’s Inferno. It’s taken me almost 2 years to ascend through the Circles of Hell and I am in Purgatory right now – things aren’t perfect, but I can see Paradise in the distance, and I’m glad I’m here.

Here’s what’s happened, and what is different.

1. When things get hectic, I no longer reach for a pen.

This change took about a year, because you have to get to the point where you don’t have to think and everything is automatic. Now I just head to the computer and type like a madwoman.

2. I am getting really good at typing while looking at my patient.

And at spell checker.

3. Most of my visits are now closed by the end of office hours.

When you are converting to an EMR, every patient is like a new patient, because you need to input their history into the computer at their first visit on the EMR. There was no time to do this during office hours, so I would catch up at the end of the day, evenings or weekends. Since most of my patients only come once a year or so, it’s taken this long to get everyone in.

This is the largest and final circle of EMR hell. But the payoff for all that hard work is that now visit documentation is a breeze – just update the meds and history, click on the exam elements, type in my notes and I am done.

4. Most of my patients’ prescriptions are now in the system.

I can bang though my refills in a few minutes by just pointing and clicking. Pretty soon, those refills will be going straight from my computer to the pharmacy, though for now my secretary is still calling them in. Cleaning out meds lists, though, is becoming a little maintenance chore.

5. My colleagues are helping me (and vice-versa).

About once or twice a day I see a patient who also sees another member of our faculty, and that doc has already completed the history, meds and allergies. That just makes me smile.

6. The EMR is changing my referral habits.

I’m starting to learn which of my colleagues uses the EMR the way I do, and which just short-cut their way through.

When you first convert, it’s extremely tempting to just start creating text notes using the text editor and macros, ignoring the custom fields for history, meds and allergies. It gets your charts closed faster. But if you just use the EMR as a fancy word processor, you’ll never see its true benefits. Plus you’ll make my life harder.

So, if I need to refer a patient to a colleague in another specialty, all other things being equal, it’s going to be the one who uses the EMR the same way I do. The docs who update the history and allergies and clean out the medication and problem lists once in awhile.

7. EMR creates transparency between practices

This is something I had not anticipated with the EMR. More often than not, I am impressed with the care my colleagues are giving. And I’m discovering some great new docs this way who I had previously only known by name.

8. Communication between docs is a snap

Just forward on lab and path reports with a brief note. No more phone tag. I even messaged my own doc to ask for some refills to mail in to my online pharmacy. Cool!

9. Of course, things aren’t perfect.

• I need our nursing staff to update meds and manage the overdue results box. (Staffing issues…).
• They need to figure out a way to input radiology appointment dates so that every mammogram I order months in advance doesn’t come into my overdue box a few weeks later.
• The lab and radiology have different systems, and the interfaces can be tricky. This means that my staff still needs to print out radiology referrals and lab slips.
• The EMR is getting too large. In another few years, negotiating through a patient’s chart is going to become a nightmare. Just scrolling down a list of visits can be time-consuming, not to mention filtering out the ones that matter, like doc encounters, from the ones that don’t, like refills. This is a job for the programmers – finding a way to have information retrievable but not in your face at all times.
• I still need a sticky note function.

10. Because of the EMR, I’m making more money.

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To read my previous posts on the EMR, go here.