TECHNOLOGY IN MEDICINE. FIVE REASONs to SWITCH TO EMR That Will Impact Your Patient Care

Transcription

1 TECHNOLOGY IN MEDICINE FIVE REASONs to SWITCH TO EMR That Will Impact Your Patient Care ABSTRACT Although many doctors have embraced and modernized their practices with a the advent of an EMR (Electronic Medical Record) system, there still a remaining majority who are hesitant to convert to a computerized recording keeping system fearing change and hassle. I have listed a few brief points urging doctors to change to a more efficient system that saves time and space which will ultimately improve patient care. In future articles, I will go into more detail of specific usages of EMR, specifically the opensource OSCAR McMaster EMR. I will also point of the issues of maintaining an EMR. KEYWORDS: OSCAR McMaster EMR, computerized medical records, electronic prescription, health information technology At the present time, the OMA reports approximately 70% of primary care physicians are using Electronic Medical Record (EMRs), with the goal of 85% uptake by Converting from the traditional paper charts and scheduling systems can be a painfully arduous task for physicians and support staff. The first 1/3 of Ontario physicians, the ones who are early adopters and mostly are technically inclined, have converted to EMR s and using them effectively in daily practice. The next 1/3 of physicians are in the process of learning. They are more reluctant. The remaining 1/3 of physicians are skeptical of EMR after seeing bad experiences of other colleagues and are holding out because of cost and hassle. I have used OSCAR McMaster EMR since 2010 and help in its ongoing development. Most physicians graduated before the beginning of 21th century are mostly comfortable in having patient charts which means writing, filing and faxing with physical paper contained in cardboard folders and stored on lateral filing cabinets. There is no doubt that EMR, when implemented correctly, will provide safer, more efficient, more ABOUT THE AUTHOR Ian PUN, MD, Family Physician, Scarborough, Ontario.

2 effective patient care without a physical medium just like the internet has changed the accounting, banking, travel and entertainment industries. 1) YOU HAVE INSTANT ACCESS TO ALL OF YOUR PATIENT INFORMATION IN SECONDS An average family physician has thousands of patients. You can review anyone s medical history in seconds. You will not lose any patient history or labs. A properly backed up EMR system will have multiple copies (hundreds) of your patients charts. CPSO dictates that all information entered into the EMR CANNOT be deleted as a medicolegal trail must exist. You can simply copy complex histories for your specialist and renew lengthy prescriptions with a click. Figure 1: Main echart screen of OSCAR McMaster 12.1 EMR where the patient s medical history, labs and prescriptions are kept. 18 Journal of Current Clinical Care Volume 4, Issue 3, 2014

3 2) YOU GET YOUR LAB RESULTS BACK THE SAME OR NEXT DAY You just click to go the actual patient s echart instantly for review in the context of the patient history. You do not need to have the staff physically pull the chart for your review. Then you can immediately recall the patient urgently or at a later time and just sign off the lab, Lab results from major private laboratories - GammaDynacare, CML, LIfelab and Alphalabs are automatically uploaded into your patient chart. OLIS (Ontario Laboratory Information System) pools these labs in the ehealth server. Most results such as cholesterol or HbA1C are automatically coded so you can track those parameters over a period of time. With the HRM (Hospital Report Manager) You get hospital reports (about 25 Ontario hospitals) detailing patients consult letters Figure 2: Labs, which typically arrive with a day of service, are also automatically filed into the patient s echart. Previous results and trends can be generated instantly. 19 Journal of Current Clinical Care Volume 4, Issue 3, 2014

4 and imaging reports. TDIS (Timely Discharge Information Summary) does this same task but only services hospitals from the CE LIHN. Sadly, downtown Toronto teaching hospitals is not on HRM yet, but eventually more will sign on. 3) ORDERs and PRESCRIPTIONS can be generated and printed in seconds. I have commonly used eforms, which are electronic versions of lab and hospital requisitions (such as Ontario Labs, Public Health Labs, Hospital MRI s). Some are even pre-checked with test requests for specific conditions such as diabetes. The patient s demographic information are automatically filled. No more searching and keeping many different forms. Just click, order and print or fax. Lengthly prescriptions can also be renewed with a click. Before EMR, I had to request the secretary to printout a patient label and find the specific form. 4) NO LOSING of CHARTS or LAB REPORTS. A properly backed up EMR system will have multiple copies Figure 3: Hospital Reports such as this shoulder MRI are automatically pushed into the OSCAR EMR and can be accessed from the echart screen. 20 Journal of Current Clinical Care Volume 4, Issue 3, 2014

5 (hundreds) or your patients charts. CPSO dictates that all information entered into the EMR CANNOT be deleted as a medicolegal trail must exist. AND because there is NO difference in PHYSICAL SPACE taken up by ten charts or ten thousand charts, you SAVE ON PAPER SUPPLIES and PHYSICAL FILING SPACE. A busy family physician will receive say at least pages of lab reports and consultation letters each day. One ream of letter sized paper contains 500 sheets of paper and is about 5.2 cm thick. If he receives an average of 125 pages a day, there will be 5.2 cm worth of paper added to his shelves every 4 days. If he works 200 days a years, that results in 2.6 meters or 8.5 feet of new shelf space a year. That is the size of a 3 drawer lateral filing cabinet. Figure 4: Prescriptions can be written after searching for the medication in the oscarrx module. You can sign the Rx in the computer screen and fax immediately to your favourite pharmacy with a click of your mouse. 21 Journal of Current Clinical Care Volume 4, Issue 3, 2014

6 SUMMARY OF KEY POINTS FIVE REASONs to SWITCH TO EMR 1. You have instant access to all of your patient information in seconds. 2. You get your lab results back the same or next day. 3. Orders and Prescriptions can be generated and printed in seconds. 4. No losing of charts or lab reports. 5. Searching records and reporting. 5) SEARCHING RECORDS and REPORTING. This is the MOST powerful feature of the Electronic Medical Report. For example. you can search and report how many diabetes patients with HbA1C over 0.07%. Perhaps, you wish to search for patients with a recalled medication like Rasilez. Or find your HBeAg-negative patients and recall them accordingly to HBV DNA. Of course, this feature only becomes useful when you accumulate years of correctly coded information actually contained in the EMR. References 1. ehealthpolicy pdf OMA ehealth Policy Paper September 2013 p handbook-e.pdf CMPA Electronic Medical Records Handbook Query By Example -Database Searches using OSCAR EMR + CLINICAL PEARLS Using Electronic Medical Record system is the modern way of practicing medicine as the high capacity of storage and fast retrieval of medical information cannot be matched by traditional manual pen and paper systems. 22 Journal of Current Clinical Care Volume 4, Issue 3, 2014