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EMR for Family Practice

February 17, 2009

As someone who will be out in practice in my late 20s, I’m keen on using technology as much as possible insofar as it can help me better care for patients. While the paperless office may be still in the distant future, digital forms of charts, lab results, radiology, and consultants letters are easily incorporated into practice. I’ve done rotations in offices that are heavily IT oriented, and in old-school, “everything on paper” clinics. Is the level of care different? Probably not. But there may be less scut work, and the technophile in me will be happy.

More and more I realize that there is too much in medicine to “know.” I’m not a good rote learner. I’m better at figuring things out, spotting patterns, and teaching people. As the amount to learn becomes overwhelming, I find myself thinking of myself as an expert who can access and apply knowledge instead of as a walking medical encyclopedia.

There are several advantages that I am personally looking forward to.

1. Reminders in the chart for chronic health checkpoints; eg. making sure Patient X has their HBA1C done regularly, reminding me to update a tetanus vaccine or start certain kinds of cancer screening. More and more guidelines are being published, which is fantastic, but I fear being able to keep track of all the things I should be doing for all my different patients as they grow and age.

2. Electronic Prescriptions. My hand-writing was terrible when I began medical school Now? One can only imagine. Typed prescriptions reduce errors due to illegibility. Medications selected from a pre-set list helps ensure appropriate dosing, and linking them to the chart means an always up-to-date drug  list for each patient [and makes it easier to check for interactions].  Prescriptions faxed or digitally sent to a pharmacy save time for patients. And in British Columbia, an electronic record of medication “PharmaNet” helps us care for patients who are unconscious, display drug-seeking behaviour, or can’t tell us what meds they are on.

We use PharmaNet regularly for complicated patients and those requesting narcotics at the inner-city hospital here in Vancouver. But medication fraud isn’t always caught. The infrastructure is there, but pharmacists need better guidance as to how to deal with discrepancies (CBC).

What are my fears? There are lots of barriers to implementing EMR, but these are what I think about:

1. Bad for patient interactions. I worry that if I’m typing in a patient chart while they are talking, the experience will be depersonalizing for them. My own family doctor’s clinic uses this technique, and it can make the appointment a little bit fragmented feeling. Doctor talks, patient talks, doctor types, etc. They bring their little laptop from room to room, sitting it on their knee as they take a history. I think it would be a bit more comfortable for patients if the computer was stationary [eg. a desktop, with a proper keyboard], and if the doctor was a good typist! I’m lucky that I’m fast, and that I prefer point-form notes. Dictation is an alternative. If I dictate a digital copy after, there may be lots of mistakes in the voice-recognition that require extra time to correct. It’s probably not worth paying a stenography service for the limited volume of dictations I would produce.

2. Compromised privacy. A universal (provincial or federal) chart would be an incredible tool. There are, of course, huge privacy issues; will sensitive data be more vulnerable online than in an office paper file? should health care providers all have access to the whole chart, or should some parts be locked (eg. psychiatric history)? Personally I feel that the clinical benefit to patients overwhelmingly trumps any of these privacy issues. If I were an American physician, I would argue that the Patriot Act is a million times more invasive and a million times less helpful for the average individual. In Canada, I don’t know. We do like our privacy. But we probably love our healthcare more.

3. Change. I’m worried that I’ll find a system I really like for my office, then a provincial system will be put in place that I’m unsatisfied with. There has been some funding pumped into developing EMRs for the province but so far, the focus is just on getting GPs to use some software, any software. The only way to get a provincial system that will be useful and efficient is to have enough physicians involved in its development.

I’m also worried that my fellow physicians may be less keen than I. But, there’s a great AAFP article about implementing change, and I’ll definitely keep referring back to it.

We’ll see. Got to figure out where to do residency, first!

11 Comments leave one →
  1. February 17, 2009 3:33 pm

    It can work! Most GP pratcies in the UK have been using online EMRs for the past few years. I work in Gwent in South Wales. The out-of-hours service can access our records, after getting consent from patients, and there is work towards secondary care having access to.
    I type my own letters, and my colleagues dictate them. The computer can sometimes be another presence on the room but generally it makes things run so much more smoothly that it is worth it:)
    Anne Marie

    • February 24, 2009 5:51 pm

      Thanks Anne Marie;
      I’m looking forward to employing them, and I’m glad to hear that it can be a fluid way to manage patient data and encounters.

  2. Alex permalink
    February 24, 2009 5:44 pm

    Have you evaluated any EMR systems and if so what is your thought on the readily available systems?
    The problem i found with the current EMR systems(even with the PITO subsidized vendors) is that they rely on almost obsolete technology.


    • February 24, 2009 6:08 pm

      Alex, I haven’t evaluated any formally as I’m not yet in practice; however the main one’s I’ve used in preceptors offices were Jonoke Med and Osler practice management.

      Having some programming experience and a ‘language and logic’-oriented mind, I often find there are gaps in each EMR system; some are really good for chronic disease management; some have better prescription writing facilities built in (including Canadian drug lists). Some interface well with popular voice-recognition software (so as to avoid employing dictation services), and others crash with every attempt. I often found myself wishing that I could take parts from each, and create some sort of chimeric hybrid. I’ll get a lot more exposure once my Family Practice residency starts in July.

      Canadian EMR blog has a good list of the popular ones, and how they’ve been rated.

  3. Alex permalink
    February 25, 2009 4:56 pm

    The reason I asked is that a while back myself and few other of my colleagues upon graduation (computer science) we started working on an EMR product. It’s been about 2 years in the making.
    Upon considering and evaluating current EMRs in the market we’ve noticed the shortcomings starting with the technology infrastructure used to the inner-workings and eventually leading to the bottom line, the price point.
    From the beginning our mission was to bring a breath of fresh air (change the paradigm) in this industry otherwise lacking the right vision in terms of technology.
    I will be working with a few interns that I’ve been referred to by one of the doctors i work with to constantly improve the system and i would like to take this opportunity to ask you if you’d be interested in evaluating the product.

  4. February 26, 2009 12:19 pm

    Pretty interesting article, what I like is that u came up with the concern for despersonalization in attention. Also recently some medical record systems from microsoft and google came up, and the issue about data integrity, security and exposition for the patient came up, I think the compromising privacy issue is a bold one

  5. Alex permalink
    February 26, 2009 2:13 pm

    please contact me at should you be interested in providing your feedback on the EMR product i’ve been working on.

  6. May 22, 2009 3:49 am

    Electronic medical record systems are nowadays very much in use in lots hospitals and private clinics. It give an easy excess to the doctors to know the patient medical history. It would be more acceptable when the EMR system is more established, like e-banking and e-commerce.

    • June 9, 2009 10:00 am

      absolutely! hopefully EMRs will be commonplace before too long.

  7. June 9, 2009 9:03 am

    EMR is a very useful software as it improves and enhances the quality of medical practice.

    It is helps in mapping the healing and treatment plan of patients, with on-the-dot monitoring of checkup schedules and other follow ups. It ensures that the service is of better quality due to the quicker movement of medical reports and other paperwork. It makes the specialists and doctors’ job better instantly by giving results they require to make the right diagnosis and suggest better treatment procedures.

    Service is the very essence of medical practice. Its revenue depends very much on the feedback of its patients. One of the best ways to beat a competitor is to deliver a better and efficient service at all times. Outstanding patient feedback is easier to achieve with dependable EMR software. In easing patient scheduling tasks, it minimizes the hassles of re-scheduling or meeting cancellations. This way, the staff can conveniently remind patients to come to the clinic ahead of time.


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