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Author: RkeFool Big red star, 1000 posts Old School Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 308481  
Subject: Re: OT: Career crisis Date: 10/18/2005 12:06 PM
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WARNING--LONG POST

On the EMR, I must open the patient visit, go to the specific module intended to capture chief complaint/history of medical illness, put the individual complaints into their individual boxes (the medical assistant does some of this), put the vitals into a different module into their individual boxes, go to the review of systems module and click off each little box regarding Normal or have to open yet another module to detail any abnormal review of systems, go to the physical exam module and click on each little box similarly to the review of systems module - and every time I answer that something is not Normal, yet ANOTHER box pops up asking me to further detail the degree of abnormality which I have to answer or close, then I have to go to the Assessment module to search the ICD-9 database for every single diagnosis I wish to document (when I know the codes it's easier but when I can't find them it's a showstopper because the program WILL NOT PROCEED without ICD-9 codes for everything). Having spent time to find the codes, I then have to go to the Plan module to say what I am doing for each diagnosis, then I have to go to the Rx module to put in every single prescription (each time having to re-enter my password because it is not set up to allow me to input it once per session or even per patient) that I wish to print out - sometimes I can't even find the desired med when I search for it - then I have to go to the printer to collect all my scripts to sign. Then I have to go to the lab module to enter lab requests that I used to simply circle. Then I have to go to the imaging module to detail requests I have for imaging - xrays, CTs, mammograms, bone density scans. Then I have to encode the results of any EKGs I've done (can't just write it anymore on the EKG itself - have to ALSO do this). And this is just for urgent care visits. For Establish Care visits, I have not even mentioned what needs to be done to capture past medical history, social history or family history on this system - each with their own modules with multipart steps for each, and none of the modules passes information forward to the payoff Assessment module which, if not completed, causes a block to closing off the patient visit.

For the love of all that is important....no piece of computer software should be that hard to use. Shoot, the more important the software, the easier it should be to use. Dare I ask what EMR software that you are running? Please don't tell me it's made by GE and has the initials CPO....... :)

For the record, I am an ex-healthcare IT employee that helped drive the implementation of EMR software through out about 60 outpatient facilities, and I have seen a number of the same issues you talk about. It definately sounds like the folks who chose that EMR software didn't do much to test the workflow and make sure it fit in with the mechanics of your practice.

The EMR we used to use was much simpler to work with, in that the data entry was much more workflow-oriented. For example, if your patient complained of sinusitus-like symptoms, you had a form built based on that that already had a lot of the commom codes related to those symptoms built into the form in a drop-down box. You only had to go searching if you needed something you weren't expecting. Also, the obs were based on standard obs for that type of visit, with a big free-form area at the bottom of the screen for other things that were not related to the primary form.

The true strength of the system was the fact we involved the doctors in the system design, and used their input to help develop these new forms for the types of visits the office normally had. That way, the OB docs weren't bogged down going through forms designed for Family Practice docs, and vice versa. I would wonder if your software has this capability, and if so, maybe you could suggest that?

And, unless you were born with a computer in your hand, people shouldn't expect EMR software to be an instantaneous boost to productivity. We actually took over two years to get back to our inital level of productivity, and an additional 6 months after that to improve. Now, the providers love the system. (But, believe you me, they had a lot of similar complaints as you have now in the beginning.)

While I certainly understand your frustration, I hope that this doesn't color your option of EMR in general, it just sounds like to me you have crappy or poorly implemented EMR software. I firmly believe that EMR is a huge step towards eliminating medical errors, and providing a consistent interface to your medical information.

The nice thing about our local healthcare providers is that our EMR is accessible from all providers that work for the company. So, if I have been to my FP doctor twice for a problem, and then end up in the ER of an affiliated hospital, my entire medical record is there for access by the ED staff.

Hang in there, hopefully you can find a happy medium in there that works for both you and your practice. :)

RkeFool
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