EMR surveys

[ozzie]

here are some surveys of EMR systems in general.. just give you a good overview of systems etc ..
http://www.medrecinst.com/uploadedFiles/MRILibrary/StatusReport.pdf
http://home.cogeco.ca/~epiphany/american-college-rheumatology-emr_whole2.pdf this is good one..
http://www.chcf.org/documents/ihealth/ForresterEMRBuyersGuideRevise.pdf

As I find more I will ad them here

oz

[macleod]

well, i've used two. don't remember the names. the goal on both occasions was a "paperless" office.
1) i don't type--except for my left index finger. i've tried, but i can't play piano either.
2) templates don't reflect was occurs during a visit. do i change what i do to conform to the templates or do i do what i was trained to do.
3) now i have to pick through template after template to find relevance, and when its not there, i have to type my note.
a note that takes me 20 seconds to dictate takes me ten minutes to do through emr.( and that's with 3 months experience on the system.
4) oops the system's down and we're a paperless office? what to do, what to do. nothing-we can't document care--oh good.
5) dragon naturally speak--no medical terminology in there. you have to train the program for everything medical-piece of junk.

[BigDoc]

Unfortunately your experiences are not uncommon, did you have enough time planning for implementation? or did you join a practice and have the EMR forced on you from day 1?


well, i've used two. don't remember the names. the goal on both occasions was a "paperless" office.
I wish you could recall which ones


2) templates don't reflect was occurs during a visit. do i change what i do to conform to the templates or do i do what i was trained to do.
You often have to make your own templates, it takes forever to create and customise, but the efforts pay off on the back end

[ozzie]

its kinda late and I am burned and I have to be up at 6 am to 4 wheeling in the snow to fix some network stuff..
but the paperless ofice is a goal just like perfect health its a target..
Hollow tubes were steths also easier to use too..
But as bad as your typing is was and could be , I bet your reply didnt take 10 minutes to type.
20 secs to dictate..
2 minutes in handling overall
then the secretary duties to get to steno and back
then rechecking that its correct
then the time to file..
Charts gets misplaced lost misfiled all the time .
Redundant system should be the standard.
Dont worry Mac~, you are not alone and down the road , when you get a system stuffed down your throat , I hope you think about the time you when you had an option..

I know you can "beat" an EMR system but I think you chose to let the system beat you ..
Come on Doc I know your smart otherwise you name would not be Dr Macleod.
I am looking for the REAL reasons you had issues .. Details give us the details ..
It these reasons that can and will make a difference down the road, if they can be fixed.. thats is

oz

[macleod]

in a general "gestalt" way, i disagree with the way my records are morphing into something they were never intended to be. by that i mean that in the dark ages of medicine(mid-80's when i graduated) medical records were a record of what occurred at a visit, so that i, as a provider, could build a picture of that person in chapter style. now that certainly led some docs to write 2 word notes and gave them the ability to put 5 years of "records" on a single page, but when their records found their way to judicial notice-ohohoh.

as judicial notice became more common(late 80's, the 90's) records became medico-legal documents. no longer the story of a single person in chapters, they became "cover your a**" documents. let me inject parenthetically, that as a former police officer, i know about the cya** doctrine in a way most physicians never will. police reports become highly "buffed" to eliminate any question of liability. so too, have medical records. as a frequnt reviewer i find the little footsteps of revisionist history in most every chart i read, because most docs aren't as clever as they think they are. and i know how to catch bad guys.

then the feds decided that my records would become the justification for my billings. when the prospect of e&m guidelines emerged, the "buffing "went into high gear, because there were dollars on the line. fortunately, e&m guidelines appear dormant for now. but the larger question is, Are patients well served by this evolution and i maintain they're not. i still believe a dictated note detailing my visit serves the patients needs and the medical-legal function, better then some template driven piece of junk. and in fact, i think we lose on the medical-legal front with emr's because there is so much extraneous junk in them. plus, juries hate anything that looks "cookbook".

those systems that i used were inordinately time consuming. each encounter had to be entered at the front, then the nurse had to enter her input and then i had to struggle through the templates, or just type my note. the most time consuming thing was that i had to code my own diagnoses to five digits, before i could type my plan and close the encounter.

the others docs that worked there typed two line notes( back to those two word notes from the old days) which did nothing to communicate the visit. the staff had designed a paper( gasp!) cheatsheet for coding that the bosses didn't know about.

i think emr's are designed by people who don't understand how health care should be documented, sold by people who could care less how it's documented, bought by administrators who are equally clueless and forced on people who are trying to take care of patients.

i found using them increased my stress level and distracted me from my real work, taking care of patients.

sorry about the length on this, but you asked.....

my finger is tired now....