What Do You Look for with the Ideal EMR?      
The main goals of any EMR system should be to enhance production and facilitate the quality of care. The two important features are simplicity of using the program and input speed, at the point of care. (Simplicity and input are directly related to the logic of the basic GUI interface of the EMR). The program should be shared with doctor and staff and no one should be intimidated by the complexities of the system. In addition, the solution should offer flexibility and custom features, so that everyone feels comfortable not only with the technical aspects of the program, but also the way in which documents are edited and created. The doctor should be able to customize the program to reflect the way they practice and not have the software program dictate practice protocol. Doctors have learned to take care of patients in a certain way, and the software and computer has to fit into the work flow, not be perceived as extra work, and not interfere with the doctor-patient interaction. Another mandated feature for me, is physical portability, resulting in, "At the point of care documentation." This equates to avoiding subsequent time, (often after office hours), reviewing and updating records on your PC or chart. Ultimately, the software and hardware, must be able to facilitate communication and save time—that’s the key.


Work Flow: 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 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.

1. 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. In my office the patient is matriculated in front of a hard wired computer in a private area. The patient is escorted back to a private room with another computer 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.

3. Next, the patient is escorted to the examination room. The patient’s chief complaints and history of injury is already completed. An examination is performed. A template of signs and symptoms is chosen from the EMR software, based on the exam findings. Changes to the template are digitized 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 VR and my keyboard at my desktop). 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).

At the point of care my chart note is complete. With 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 que. 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.

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.

The TabletPC makes it all possible!

"Good software makes us think, good hardware and software, changes our lives."

C.M.Wilkerson, D.C.
Editor-in Chief