My Electronic Medical Record Reality

I love my electronic medical record (EMR). I can type about 100-110 words a minute, but I just installed Dragon Medical.  It is amazing.  I can now dictate 600 words per minute.  My day just sped up and I might make it home for dinner!

Those of you that know me know that I have been using an EMR since 2002 when I opened my practice.  Many people I spoke to told me I was "nuts" to consider practicing Solo.  When I told them I had purchased and EMR they would roll their eyes and moan.

Times have changed slightly.  Recent data states that 36-41% of physicians are using at least a partial EMR/EHR this year.  That's up from 17% just two years ago. Much of this change is due to the government mandate to adopt electronic health records (EHRs) by 2014.

So, why am I a fan?  Yes, it feels like another government push to monitor our actions and control our decisions. And yes, they changed the acronym, too. But, I think there are some benefits to be had with these changes. Before congress ever got their fingers on it, I realized that EHRs could offer me five areas of freedom.

Automation:
In medical school and residency I found that I was often rewriting the same information over and over and over . . . . "Cardiovascular exam reveals heart with a regular rate and rhythm without murmur.  No lifts or thrills. . . " And one day I thought, "That's true, there are no 'lifts or thrills' to writing this again and again."  I found that in most cases I was re-writing much of the same information multiple times each day with only a few differences between patient exams. I remembered some basic programing skills I picked up in junior high school demonstrated then that I could get a computer to write the same things repeatedly a whole lot faster than I could write them with my black pen (and it would be legible, too).


Efficiency:
I knew that my home computer could calculate my checkbook for me, and my telephone could store all my contacts at my fingertips.  Why couldn't my office computer make my writing of chart notes easier, more legible, and then transmit that data to a pharmacy or to a lab?  Why couldn't I have all my laboratory data in on place that I could compare and trend?
I realized two very important things.  First, doing today's work today (and actually finishing it) seemed to make me feel better at the end of the day.  Second, I spent 13 years of my life and thousands of educational dollars learning to make difficult life-or-death decisions. If what I am really being paid to do is make important decisions, then why am I doing all the other stuff that takes up all the time in my day? I found that on days I made decisions more efficiently and finished all of the day's work today, I felt much happier.  The sky seemed "bluer."


Mobility:
I can't tell you how many times I have been at the grocery store or at the restaurant and a patient would call with a question about a lab or an x-ray or a medication that my Physician Assistant had written that I knew nothing about.  Isn't there some way I could use the same phone that I carry around everywhere with me to check these things?  I could use my phone in real time to check stocks, my bank account, and see the dress made of steaks Lady Gaga is wearing.  Why can't I check my charts?  Well, now, I can, and I do.  I use Remote Desktop for Android by Xtralogic. Once in a while, now, I can enjoy the blue sky.


Legibility:
My handwriting looks like chicken scratch, especially after a long day. The busier the day, the more hen pecked it looks.  I found that I can type or dictate much faster than I can legibly write. Why am I still writing in paper charts? I'm not.  My nurse transcribes the first part of my note in the room for me while I do my examination.  Then, between patients, I put the finishing touches on my note with Nuance's Dragon Medical voice recognition dictation software that works seamlessly with my EMR.


Writer's Cramp:
With an electronic medical record I no longer get writer's cramp.  My third finger no longer has that painful callous; now I just have to avoid carpal tunnel.

Retrieve Data, Understand Data, Make Your Decision:
I remember as a medical student some great wisdom from on of my supervising residents. He stated that we were trained to make decisions, and any tool that would help you rapidly retrieve the data, rapidly understand that data, and then make relevant decisions based on that data was well worth its cost.  Well, I found that is exactly what the EHR does and they can be fine tuned to do it for you individually.

So, I dove in head first.  I looked at a number of systems.  I demoed a number of systems.  Two of my favorites took up an entire Saturday playing with them on my home computer.  I quickly realized which one I liked after playing with the demo for an hour.

Colonoscopy Anyone?
I will warn you; however, selecting and implementing an electronic health record is like having a GI prep and colonoscopy without the sedation.  It can be done, but it can be unpleasant.

It took an entire day to load the software on each of the workstations and server in my office.  It took another 2-3 days to train my staff to use the software.  It took us 2-3 months to realize that the computer will change the workflow drastically.  (It took me a week to realize that there is nothing wrong with changing the workflow.)  It took me a month to realize that you can practice medicine "outside the box."  The workflow methodologies you learn in medical school and residency and establish in your office are malleable.  And often your efficiency drastically improves when you accept this and then change them.  There is a learning curve.  When you accept this curve and stop fighting it, using your EHR becomes enjoyable.

What really makes it worth while is when all the parts of the puzzle fall into place.  Lab interface, electronic prescribing, interoffice and inter-patient communication links allow streamlining of processes. You really can do today's work today.

Yes, I know. I neglected to mention which system I am using.  I couldn't do that.  Praxis.  I use Praxis EMR and I love it.

(The first in a series of articles on EHR adoption, use, and integration)