Electronic Medical Records Implementation Made Easy
Implementation of an Electronic Medical Records (EMR) application in a medical practice is widely perceived to be difficult, expensive and risky. ‘Experts' advise careful planning, equipment selection and staff training, and warn that even then you may lose productivity for a time.
But this needn't be the case. Implementing an EMR application can be done with the same efficiency and ease as other office applications; especially in a small practice. It doesn't have to be expensive, and it can be undertaken with minimal risk.
Implementing EMR in Stages
An Electronic Medical Records application is fundamentally a database that you can use to manage various categories of medical information for each of your patients. Among these are medical problem lists, medications, allergies, lab results, patient histories, and your patient care notes. Most data categories are independent of one another. That is, you can enter a patient's medication into the EMR without entering any of his lab results, and you can enter a patient's lab results without entering his medications. In this respect, the EMR application mimics the paper chart, which is composed of independent paper records.
Thus you can begin to use an EMR application by working with a single category of data while you continue to follow your current practices for other information. This ensures that the change of habits and methods required to transition to EMR will be manageable. You can add subsequent categories at your own pace.
Labs First?
Which category should you begin with? Pick one that will bring an immediate benefit to you or your staff. In an internal medicine practice, this might be the recording of lab results. A surgeon who does a lot of dictation might find that the ability to enter reports directly into the EMR application, either by speech recognition or with templates, would be a good place to start.
If you begin with lab results, which usually come from an outside lab by fax or by transmission and printing, the best option is to have them entered into the EMR application electronically. Lab results can be sent directly to your computer, and your EMR application can read them in and place them in the correct patient's chart.
But what happens if something goes wrong? What if the technician who is setting up the connection wins the lottery, and quits? You can easily return temporarily to the original way of handling lab results, which are still coming to you just as before, whether by printer, fax or pony express, and you can still use them. No other part of your computer operation is affected, so there is minimal risk to your practice.
When the lab connection to your EMR system is completed, lab results will be available on your computer, faster than before, and you will be able to look up all the results for a patient, both for current and prior lab results, usually viewable on the same screen. Better yet, most EMR systems will send you an alert when a result is abnormal. The results can still be printed so you can read and file them in the patient's chart, which you will still be keeping (because going paperless is the last step in implementing an EMR application, not the first).
In summary: You bought a computer (or used one that you already had), purchased an EMR application (or downloaded one free*), installed it, and let your primary lab start downloading results. Your costs have been minimal or nil (or paid by the lab), there has been little stress on you, and you have an EMR system up and running in your office. It gives you lab results and alerts more quickly that you can examine with less time and effort. It's a pure win.
Meds First?
Suppose you decide to begin your migration to EMR with medications records rather than labs? You could start by installing the EMR application on a computer you already have - even a laptop computer. If you don't have a computer, it may be time to invest in one of the many new, affordable computers on the market.
You can begin by simply recording your prescriptions. On most EMR systems, this is very simple, and it can be done either by you or an assistant. The assumption is that your patients' names are in the EMR system already - this might have been done at your registration desk, or by importing all the names from your medical practice management application. If your practice management and EMR applications are an integrated system, the patient information is already there.
The least change to your existing routine would be to continue writing prescriptions by hand, as you have been. You could use a two-part pad, so there would always be a copy. Then a clerical staff member could enter the data into the EMR system. Though this requires clerical support, the impact on clinicians would be very low. A convenient alternative would be to enter the prescriptions yourself on a laptop computer, and let the EMR application print them on a nearby printer. Finally, you can have your EMR send the prescriptions directly to the patient's pharmacy. By doing this, you'd benefit from easier handling of requests for reissue, drug and allergy interaction checking, and accurate, rapid delivery of the prescription.
Electronic Medical Records - Minimal Change Minimal Risk
You can implement an EMR application without drastically upsetting the routine of your office, or your own work. Don't try to begin using all the system's features at once; begin with a single feature that will give you an immediate benefit. Implement those features that will help you improve patient care and make your life easier, and ignore the others. The computer is there to serve you, not the other way around.
The key is to minimize risk. You don't need to spend a lot of money, and you have the ability to change your mind at any time. By implementing in stages, you can bring your medical practice into the realm of electronic medical records the easy way.
About the author: Mr. Landau is founder and CEO of . VersaForm designs and develops medical practice management, Electronic Medical Records and clinical software to enable healthcare organizations to use computer and network systems for greater efficiency.
* VersaForm currently offers several electronic medical records applications which can be downloaded at no charge from the company's website, .
