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Flexible EMR for a Flexible Practice

Many physicians worry that EMR is too cramped and limited for their specialty. They're concerned that a one-size-fit-all EMR is not appropriate for their clinical needs and can't help them provide excellent service. This is a legitimate concern, but if they're careful, it shouldn't be a problem.

Ophthalmologists, cardiologists, and dermatologists all have special needs for images, lab results, and the contents of their charts. SOAP notes are rarely the same for two different medical specialties.

This concern shouldn’t be a problem if the designers of the EMR software included an easy way for you to tailor the charts and forms to your personal preferences and clinical requirements. Look for a flexible system when you shop for EMR. They're out there. Don't let yourself get locked into rigid, frustrating software.

What a Good EMR System Could Offer

You say you don't want the fanciest model on the street. You want a go-cart with wheels, not a Formula One racer. What will you get with a basic model?

You should be able to scan documents into a file or chart using the name or number of a patient. You can dictate, write, or type data into a blank form or by clinical category. You can enter clinical decisions at the point of care and print prescriptions or other forms in your office. You can access your EMR with a table, handheld computer or cell phones that give you internet access.

You should be able to share with other practices a record of your patient’s medical, family and social history and other traditional chart information. You can track lab orders and receive results from laboratories. You can view your lab results on a flow chart or graphs. You can review previous visits and active medications, plus meds that you and other physicians have prescribed. And you can beam e-prescriptions to pharmacies.

Almost above all else, a good system should allow you to quickly and easily alter templates to fit your specialty and personal preferences.

Copying from Paper to Digital

If you’re like most doctors faced with switching to EMR, you likely have several thousand paper charts. What do you do with them? You can scan them into EMR as a PDF file (Portable Documents File made popular by the Adobe reader.) It can cost real money to hire somebody to scan four to five thousand charts into your EMR system. You can hire a service that will bring people to your office and scan your entire practice. Is it worth the cost to scan all the files? Before you hire a scanning service, it’s a good idea to clean up your charts before they begin so you’ll have better images and fewer pages to scan.

Once you pull a chart, the space it occupied is no longer productive, so some doctors scan charts as patients arrive. Your staff to scan the last several lab results or the notes of a patient’s last half dozen visits. This will vary. What is important depends on the specialty and a patient’s particular problem.

EMR Contingency Plans for Emergencies

All offices installing EMR need to have contingency plans for emergencies—suppose an ice storm drops power lines causing an electrical blackout. Hospitals ordinarily have emergency power generators to run lights, respirator, operating rooms, and computers. You might not have access to an emergency generator.

You need to train people what to do in case of an emergency. Your contingency plans should include a manual with step-by-step instructions about what to do. You should periodically review those plans. You should stage a mock emergency a couple of times a year to make sure everybody knows what he or she is supposed to do in case of an electrical failure. Safety precaution tips hang in office walls could also help.

An electrical blackout can more than affect computers; you’ll have problems with the electrical interfaces with all your equipment. You’ll need a backup paper system to document data while your EMR is down. You’ll need that so you can later input it into your EMR.

If you run your EMR software on your own computers, the system should record regular backups. If your EMR system is stored on computers maintained by your vendor, your data should be safe. (Your vendor should have a generator and duplicate systems.) If you have electricity from home, you can access data stored in your vendor’s computer until the blackout is lifted from your offices.

EMR Planning and Training EMR Committee

A further suggestion on the critical need for good planning and training. It truly is asking too much that a system as complicated as EMR will be glitch free. Even Microsoft has to send out patches to fix problems.

Physicians should designate somebody in their office to monitor their EMR and make sure it’s working correctly. The vendor’s technical people will want to talk to somebody who knows exactly what went wrong.

This person should also manage EMR templates and work with doctors to find out what they want. In a large practice, this staff specialist should interact with the vendor to update templates.

A small EMR committee can ensure that workflow trumps seniority.