Work Flow on TabletPC or PC:




Using an EMR can and should be as simple as 1234. An EMR should be shared with all pertinent staff members in order to enable a triage approach to care and data input. When networked, other staff can input data besides the doctor, in "real time," enabling a Triage Approach to patient care. For example, a historian can prepare the History, PMH, PSH and ROS, the front desk the demographics, a nurse the vitals, all prior to the doctor examining the patient. (IMH or Instant Medical History, would involve having the patient participate in the input instead of the staff). Then, the doctor completes the physical exam and then digitizes the exam findings and chart note. Even though I am a proficient typist, I prefer to avoid typing and hence delegate typing to others when possible. It's all about communication. So simple, yet so complex.
 

1. Check In: When a patient makes an appointment by phone they are put into our multi-appointment computerized Calendar, which is at the front desk computer. When the patient actually enters the office, they are greeted by the front desk and then…..

2. Matriculation: Ideally, this would be done online by the patient and imported into the EMR. Most of the time, the patient is matriculated in front of a hard wired computer, in a private (HIPAA) area. The patient is escorted back to a private room that has all the patient information with respect to insurance, billing, and history. (Matriculation). The patient does not fill out any paperwork, because the secretary asks her all the questions and types in the information onto the computer screen in front of the patient. This screen can be printed for a hardcopy in the patient record folder or better yet it is printed/archived to the hard drive as a searchable pdf file in a document management software integrated with the EMR. Ideally, but not always realistically, the patient can fill out their own demographics, complaints, ROS, History etc., either online before they come into the office or now in the office.

3. Exam: The patient is escorted to the examination room. The patient’s chief complaints and history of injury is already completed and viewable.  All the incorporated information is on my networked Tabletpc. An examination is performed. A template of signs and symptoms and findings is chosen from the EMR software, based on the exam findings. Changes to the template are digitized and edited as determined by exam findings. I use a combination of voice snippets and handwriting to text, at the point of care. Other customized changes are executed with a series of pen clicks on editable choices. (On rare occasions, if I need to type a lot, I will use my keyboard at my desktop). I use DNS 8 on my TPC at the point of care subsequent to the patient leaving the room. This leaves me with plenty of VR quiet time to polish a note. I am still in need of an EMR that takes full advantage of inking, despite the fact that data is more useful as text (data mining).

4. Chart: At the point of care my chart note or exam is complete. With G Wifi and my shared network printer, I can print the note, or I can populate/merge the patient data into a number of custom reports, letters, orders, scripts and or educational material. My TPC prints via wifi to a laser printer at the front desk or I can send the document to a fax queue. If the document is for the patient, I tell the patient that what I am printing for them is at the front desk. The front desk staff always gets the paper work before the patient arrives at the front desk. Example a Welcome Letter.

I don't print charts on a daily basis. I avoid producing paper when possible. I only print when needed. My EMR allows batch printing, by date. So I only print when needed. My notes remained digitized on my computer. Backups are a mandatory and critical necessity.