of Time and EMRs
After almost a year and a half of using an EMR, I think it saves me
time. There is no question that it saves a lot of administrative time
for my staff: there is no pulling of charts, things don't get
misfiled, and accessing data is a lot faster when patients call for
results. That is partially counter-balanced by the need to scan and
file non-electronic data, but still accounts for net time-savings.
However, saving physician time is less obvious; I think the EMR can
help to save time, but you have to organize yourself to do this. I was
away for two weeks, with essentially no Internet access. When I
returned, there were 52 labs, 26 Diagnostic Imaging reports, and 58
correspondence reports waiting for me. There were also 10 staff
messages. I had budgeted time on the day before I came back to go
through everything; it took about four hours to review all the
reports, and to send appropriate messages for my staff. The time
savings here happened because I was able to review the data by logging
in from home instead of having to go to the office. Prior to EMR, I
sometimes tried to do this while booking a full complement of patients
on my first day back, which was inevitably a disaster.
I do not routinely finish recording patient encounters during or right
after I see patients. Much of the numerical data (vital signs) is now
entered by my staff before I see the patient. Some of the data, such
as a note that a patient is in for a routine diabetic visit or a
routine BP visit, is quickly entered using a drop down list as I start
the encounter; the reason for that is that it takes only two clicks
and does not interfere with the interview. I usually will not load a
template, such as an Upper Respirator Infection, when I see the
patient, because I don't want to fill in this data instead of
attending to my patient's needs; instead, I'll use free text to write
"URI x 2 days". The free text reminds me to load and fill the template
later. If there are significant abnormal findings, I'll note those in
free text. The templates are especially useful for noting normal
findings. I'm not sure I save time; however, my records are more
complete.
When I am finished seeing a patient, I'll often go on to the next
patient instead of completing the encounter. I don't like to make my
patients wait, so the visit takes precedence over record completion; I
note the abnormal/significant results during or right after the
encounter, and the rest waits. The alternative is booking fewer
patients so I can finish recording encounters.
Because of this, I have routinely have uncompleted visits at the end
of the day. I allot one hour to complete my records, return phone
calls, review and file reports, and finish insurance or other forms.
The difference with EMR is that I can leave for home if I'm tired and
not finished by then, and I don't lug charts home. I find that it is
not as painful to finish completing charts after I have supper with my
family. Prior to EMR, I had some charts left for completion for a
couple of days (which I know is less than ideal); this no longer
occurs. It is unusual for me to have a practice summary showing more
than one or two tasks undone at the end of the day; most often, there
are none; everything has been done.
The difference here with EMR is the ability to complete tasks more
quickly, and to have fewer pending reports. My patients have commented
on how fast we get forms back to them.
Electronic lab reports seem to come in overnight, mid-morning and mid
afternoon. I'll review them before I start my office, so that I can
send a message to my staff if needed. I'll review them again at lunch,
and before I leave the office in the afternoon. Non-electronic reports
get scanned in the afternoon, so I'll review those at the end of the
day. If it is a bit quieter, I'll do that between patients. Time
savings for me stem from the fact that lab results go automatically
into flow sheets (no duplication), and from having the ability to look
at trends easily. Actually reviewing reports takes the same amount of
time; there are no EMR savings there.
Inter-office messaging is much more efficient. For non-urgent message,
my staff writes an e-note which is automatically attached to the
patient's chart. A little "M" appears at the bottom of my screen to
let me know I have pending messages. I check those periodically, and
will often send a note back for my staff to call the patient. We also
have pop-up messaging for instant communication, and my secretary can
always knock on the exam room door if needed. This has led to quicker
turn-around to return messages, and fewer phone calls in the evening
for me, as the majority of messages can now be handled by my staff. In
order to save time here, you and your staff have to use e-messaging
consistently, and you have to work with and trust your staff to return
messages appropriately.
I think the conclusion is that we have to work with our EMRs and
figure out where they will save us time; this won't happen by itself.
One of the best ways to do this is to find out what our colleagues are
doing; I am starting to see some forums for exchanging ideas, such as
the new EMR Advisor on our provincial website, OntarioMD.
I can see that if I didn't work on my office procedures when the EMR
came in, I was just in for endless frustration. Investing time up
No comments:
Post a Comment