How do those without EMR manage?

[mel]

I have always wondered how my colleagues who either because of financial constraints, or other reason don't have any EMR manage to track all the patients on Coumadin, statins, health maintenance? Do u do a chart audit ever 3,6 months? Do you have a lab book?
Please let us know

[hirschr]

-3x5 cards for lipids, physicals
-appoinment for next protime before they leave the office
-keep copy of order sheet for xrays ordered
-if I tell a patient to see a specialist, I send a referral letter and keep it to track

...but I'm shopping for an EMR. Who doesn't have financial constraints???

[emr]

monthly fee to hold data after the trial.

[LGrant]

There was a thread a few days ago about EMR wish-list, when we get critical-mass on here, we should re-run it, I wonder whether we should run the thread in the open forum or not, open forums tend to attract EMR sales reps:rolleyes:

[LGrant]

Hirschr, how often do u go thru the cards? Do u do it yourself, or let the nurse do? I tried the spreadsheet posted on here, looks like it is a workable solution if the author could complete it, it has potential, and the price, you cannot beat...free

[Mike]

My prediciton is, the fed gov will step in, provide standards, and (hopefully) heavily subsidize EMR development based on these standards, and make EMR available in almost every office, but we are looking at maybe 10 years.
Mike

[DrWinn]

My prediciton is, the fed gov will step in, provide standards, and (hopefully) heavily subsidize EMR development based on these standards, and make EMR available in almost every office, but we are looking at maybe 10 years.
Mike
Yep,

Dr. David Brailer, appointed by Bush, is fast tracking EMR standards. This CCR (continuity of Care record) was initially promulgated by MMS and HIMSS and will become the basis by which all EMR systems share patient data. I suspect that EMR use will eventually be mandated and that only CCR capable EMRs will be certified. Products that lack a codified vocabuolary like Praxis, Word macros and Dragon Dictate will have a difficult time meeting this standard. Most industry experts expect EMR penetration at 50% by 2010. I think we hit 50% by 2008.

Good luck EMR hunting!

David Winn, M.D., FAAFP
CEO, e-MDs

[LGrant]

Yep,
Dr. David Brailer, appointed by Bush, is fast tracking EMR standards. This CCR (continuity of Care record) was initially promulgated by MMS and HIMSS and will become the basis by which all EMR systems share patient data. I suspect that EMR use will eventually be mandated and that only CCR capable EMRs will be certified. Products that lack a codified vocabuolary like Praxis, Word macros and Dragon Dictate will have a difficult time meeting this standard. Most industry experts expect EMR penetration at 50% by 2010. I think we hit 50% by 2008.
Good luck EMR hunting!
David Winn, M.D., FAAFP
CEO, e-MDs

Welcome,
CCR is in the right direction, long overdue, and more important than HIPPA.
L

[Kursk]

Dr. Winn please elaborate on "codified vocabulary" and its importance to patient care, standards and EMR selection

[DrWinn]

A structured vocabulary would be discrete data elements captured in a patient visit like personal hx of NIDDM or family hx of melanoma. Within the same EMR system, one could query the data and identify all patients with certain findings, or on certain drugs - even perform epidemiologic data mining and pattern recognition - (ie. clusters of bloody diarrhea and intussusception in infants administered rotavirus vaccine). Structured data, however, has no meaning outside of the vendor's propietary format as other systems cannot aggregate this information. A codified vocabulary, on the other hand, is based on a recognized 'structured' vocabulary like Medcin, SnoMed, HL-7, LOINC or even e-MDs, and is applied to all clinical systems. This allows disparate systems to aggregate and potentially share data. This is the goal of CCR. The challenge is to avoid applying too rigorous of codified data standards as this will slow documentation time down to a crawl and create barriers to EMR adoption ("don't slow me down!"). I have recently become involved with the standards process thru HIMSS and the AMA and hope to impart some wisdom to the process at a meeting with the AMA, Dr. Brailer and Medem in Washington this September. Hopefully we can avoid the ivory tower over-engineering that the academics want to apply and come up with a core basic requirement that works well in busy clinical environments. To help spur EMR adoption along, we are open sourcing our medication database (similar to mySQL licensing) and, god willing, will also get buy in from the vendor community for our clinical lexicon and other intellectual content. While I can't give away the whole enchilada and still stay in business, we can share a great deal of our development and avoid everyone having to re-invent the wheel.

Does that answer your question?

There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

[DrWinn]

Dr. Winn please elaborate on "codified vocabulary" and its importance to patient care, standards and EMR selection

Sorry, I left out importance to patient care and EMR selection.

Once CCR is in place, then buying a 'certified' EMR from a vendor will make it possible to switch EMRs and/or see patient data stored in other EMRs without feeling like you went thru a root canal (although mass transition to another system may still entail some discomfort :eek: ) Various EMRs will differ in their price, ease of use, speed of documentaion and feature list, but will store essentially the same information. It will become down to test driving and deciding which "EMR" car you want to buy to drive 8 hours a day.

Patient care is improved when clinical decision support is available like best practices for certain illnesses (ACE or B-blocker for CHF, ordering BNP for CHF Dx confirmation), drug-drug-disease interactions, etc. Globally, the ability to aggregate data and outcomes from a large, distributed patient population helps with epidemiological research and even bioterrorism detection and action plans. EMRs should not only decrease medical errors, but should help standardize care along validated, national treatment guidelines (also known as cookbook medicine). Strictly speaking, many of these goals can be reached without codified data. However, it takes codified data to accurately and rapidly aggregate patient data from multiple sites and visits and perform outcomes analysis.

[mel]

Once CCR is in place, then buying a 'certified' EMR from a vendor will make it possible to switch EMRs and/or see patient data stored in other EMRs without feeling like you went thru a root canal (although mass transition to another system may still entail some discomfort :eek: ).

This day cannot come soon enough, when I can read some other EMR data file with a different one,
remember Wordperfect vs Word in the late 80s?
M

[LGrant]

There are only 16 types of people in the world, those that understand hexadecimal, and those that don't.

that is funny :p

[doc0875]

My question is how do you track those things WITH an EMR? I have Alteer and I have no idea how I would track those items you mentioned.

David

[mel]

My question is how do you track those things WITH an EMR? I have Alteer and I have no idea how I would track those items you mentioned.
David

Have you tried the vendor? Send a PM to Dougdykman (http://www.docsboard.com/forums/faq.php?faq=vendor_list#faq_alteer), he has been using Alteer for several years.
Mel

[dougdykman]

Alteer has a Recall function -- I believe that it was custom created for our practice, and assume that it was integrated in all practices. In the patient face sheet use the button that you use to create messages, and there is a recall option. It will show up at the bottom of the facesheet once entered. I know that there is a reporting system to tell you when they are due, but my staff does that, so I don't know the detials.

[doc0875]

I will PM him. However, other Alteer users have alreadsy told me that the inability to track chronic dz is one of the majot shortcomings of the Alteer EMR.

David

[dougdykman]

we use the recall function. As a GI group, we don't have the tracking of HTN, DM, etc. issues that you do.
]
We dictate our notes [takes to long and dosen't read nice enough for our referring docs if we use templates] and out transcriptionist faxes it back to us.

[doc0875]

You use Alteer AND still dictate your notes? Doesn't that sort of defeat a lot of the purpose of having an EMR (ie, the cost savings of all of that dictation)?