EMR for Family Practice
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!