Setting them up…

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Electronic Medical Records are like bowling pins.   If you don’t set them up properly, they are not going to work like you had hoped.

The first choice is the most difficult.   Stay with paper, or make the expensive and time-consuming transition to digital records.

If you DO choose to go with an EMR, you will need to pick a system that is right for you, which will do what you want, and which will be durable.

The following guides were originally published by the Canadian Medical Association and the Canadian Medical Protective Association respectively, and have some sage advice for those contemplating change.

http://www.cma.ca/practicemanagement/electronic-medical-records

http://www.cmpa-acpm.ca/cmpapd04/docs/submissions_papers/com_electronic_records_handbook-e.cfm

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You can’t tell the players without a program…

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Well, maybe.   Almost everyone will recognize Maurice “Rocket” Richard.   And that might be Johnny Bower in the nets for the Leafs.  But who are the guys in the background, and what were their hockey credentials?   Unless you are a true hockey aficionado, your guess is as good as mine.

So it is with EMRs.   There are a lot of them out there.   Some are well known.   Others are fringe players that may only last a year or two, then disappear back to the minor leagues, or give up the game entirely.

It’s good to have some way to know who’s who.

Taken from “canadianemr.ca” the following webpage outlines which EMR vendors were provincially approved as of May 2013.   It’s not quite complete.  Manitoba has three approved vendors, and when this summary was originally posted NBMS had approved a provincial monopoly for Velante and it’s software vendor of choice, Intrahealth.

All other provinces offer a choice, some more than others, but not New Brunswick.   At this point in time, it’s Velante, take it or leave it.  At least if you want any help from the NBMS, the Department of Health, or Canada Heath Infoway.

Only in New Brunswick, eh?   Pity…

http://www.canadianemr.ca/index.aspx?PID=50

Reading between the lines…

 

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The following commentary was passed along by one of our local psychiatrists.   It suggests that not all psychiatry notes need to be part of the electronic medical record, and advocates for a dual system where psychiatric progress notes are kept separate from psychotherapy records, then explains why this makes good sense.  My thanks to the contributor.

http://psychcentral.com/blog/archives/2012/06/25/should-psychotherapy-notes-be-a-part-of-your-electronic-health-record/

Big Brother is watching you…

I was in the hospital yesterday and wanted to show a friend this blog.   I tapped on the bookmark to bring the site up and, much to my surprise, this is what I got:

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“Potentially Damaging Content?”   “Blocked for my own protection?”  It’s my own fracking site!  Did I miss something?   Have I been declared an enemy of the state?

Probably not.

Probably the Horizon I.T. department has set up a firewall which routinely blocks access certain types of sites, in order to ensure that people are not wasting time at work, surfing frivolous or subversive sites, and taking their attention away from their designated duties.   Fair enough.   There is a lot of garbage on the web, and it seems reasonable to have some sort of filter to keep the flotsam out of the drinking water.

Being a curious fellow, I decided to do a quick check to see what other “potentially dangerous” sites might be banned.   Well, it appears that Horizon doesn’t want you buying guns online.  Seems reasonable.   Neither can you look for a date on “eHarmony.”  Fine by me.

But, astonishingly, there are a myriad of questionable sites that you CAN access, and which are not filtered by the firewall.  Here are some examples of things you can do:

1.  Watch the trailer for the execrable movie “Jackass – Bad Grandpa.”

2.  Inform yourself about the North American Man-Boy Love Association.

3.  Order some Lakota herbal products.

4.  Check out what the Canadian Communist Party has to offer.

5.  Learn all you need to know about Britain’s Monster Raving Loony Party.

6.  Sign on with the Church of Scientology.

7.  Join the Flat Earth Society

In short, the firewall effectively blocks you from seeing the musings of your’s truly, while allowing unfettered access to a cavalcade of ill-mannered wastrels, pederasts, religious fanatics, daft-pranksters, snake oil salespersons, fringe political organizations, and, well, Raving Loonies.

Make sense to you?

To be fair to the administrators of Horizon’s internet service, they have offered to see what they might be able to do to make this site accessible.   For now, it’s wait and see.  In the meantime, I suggest you read what Charles LeBlanc has been posting.   They don’t block that one.

What a drag it is getting old…

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The older I get, the crankier I seem to be.   It used to bother me, but… I’m over it now.  So let’s just move along to today’s commentary.  And the topic for today is… Pharmacists!

We all love pharmacists.   They are highly trained professionals who are a key part of our health care system.   It is often very helpful to have someone take a second look at prescribed medication dosages, review potential drug interactions, and advise patients of possible side effects.   They function in many ways like the Canadian Senate, giving things a sober second thought, but without the perks, arrogance, and scandals.

They have recently expanded their scope of practice to include giving immunizations and advising patients of what over-the-counter medications they can take for a number of common ailments.  All of this is mutually helpful.  It takes some of the burden of care away from the traditional primary health care providers, and generates some additional revenue for the pharmacies.

So, you may be wondering, where’s the beef?

Glad you asked.   You may have guessed that this might, in some way, tie in to EMRs.   It does.   

When I started using my EMR three years ago, I was very excited to learn that I would now be able to fax my computer generated, electronically signed prescriptions directly to the patient’s pharmacy.   What a boon to patient care, I thought.   The pharmacists are going to LOVE this.  Legible prescriptions, faxed to the order desk before the patient has even left the doctor’s office.   Amazing!

That’s when I learned the awful truth.   Pharmacists in New Brunswick are not willing to accept a prescription which is computer generated.    They will take an illegible handwritten scrawl on a napkin.   They will take a computer printout that has been hand-signed, digitized by a fax machine, fed through the ether, and reconstituted  at the other end.  But apparently, a fax-by-computer, clearly noting the phone number of origin and plastered with anti-forgery watermarks does not cut the mustard.  

Well my pill-dispensing friends, the time has come to join the new millennium.   There is no reason, I repeat, NO reason not to accept a computer-generated prescription.   Many other jurisdictions do it.  It is more secure than what you get now.  Plus you are already accepting computerized signatures from other sources.  For instance, when was the last time you refused to accept a cheque issued by the federal or provincial government?   Despite the fact that they are signed by machine, they still can be converted into useful cash.  

In the ongoing process of improving the quality and efficiency of health care delivery to the citizens of this province, doctors and pharmacists are key players.   The old ways of doing things are changing, mostly for the better.   In the spirit of the times, would it be too much to ask that pharmacists take this small step to embrace the benefits conferred by the new technology?

Need to know basis…

For Your Eyes

The “One Patient, One Record” plan has been much ballyhooed by both our provincial medical society and the NB Department of Health.   Don’t get me wrong, I think the concept of having a single accessible medical record for every person in the province is a great idea.   But there should be some constraints on who is able to see what, and respect for patient privacy deserves top priority.

It seems to me that if a primary care practitioner is seeing a patient for the first time, it would be EXTREMELY helpful to have access to that patient’s recorded medical history.   Paper charts are OK, but they tend to be disorganized, have “legibility issues” (euphemistically speaking), and are a usually miles away, locked in a closed office when you really need them.

Electronic records seem to be the perfect solution.

The other question is this: if you are assessing a patient in an after hours clinic, do you really need to know EVERYTHING about their medical history?   Keep in mind there will be many things in that chart that may have been told in confidence to a trusted family physician, who the patient has known for years, and with the expectation that nobody else will be reviewing the office notes.   Just to name a few sensitive issues that may be in the chart: 1) requests for STD testing from a patient who suspects their spouse of marital infidelity, 2) discussions of workplace conflicts, 3) remote substance misuse history, 4) personal beliefs and religious views.

Now there could be some situations where information like that may be required.   That’s why we take a history from the patient.   Most of the time, most of the stuff you find in a complete chart is dross, and not relevant to the current issue.   So why make it available?

I think the solution is to have a limited “One Patient, One Record” system which provides the key points of a patient’s health history in one or two pages.

Here is a sample of what that would look like, taken from my EMR.

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What do you think?

Speaking of Hippocratic oaths…

Sometimes computers are enough to make you swear.

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Before I went back to university to finish my BSc and try to get into medical school, I had a few weeks here and there when I was “between jobs.”   At the time I was doing some freelance reporting on an irregular basis with the CBC.  I used my free time to teach myself how to type.   It was laborious, repetitive, frustrating, but ultimately rewarding.    As a result, since the mid 80’s, I am a competent, but not expert, touch typist.

This basic skill has come in very handy with the EMR.    So useful, in fact, that I can’t imagine how frustrating it must be to enter clinical notes by the “hunt and peck” typing method.    I would imagine that it must feel something like the poor fellow depicted above.

A word to parents:   make sure your kids take that typing course, or learn it on their own.    In the long term, it’s one of the most useful skills they will ever acquire.

The American Journal of Emergency Medicine published a report in September of this year, that made some perhaps surprising revelations about how much time emergency room doctors spend at the keyboard.   Clearly it’s a double edged sword.   There are benefits with regard to orderly and legible record keeping, and in locating and reviewing existing data, as well as drawbacks in terms of time away from the bedside and  the possibility of decreased departmental “throughput.”

If you would like to read a summary of the report, you will find it here: http://www.medscape.com/viewarticle/811841