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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. 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
www.MedicalTabletpc.com |
