Tips for New Users of EMRs

Do you have any tips or suggestions for new users of EMR systems. Share your experience with other users. Click on the 'Comments' link below this posting and type your tip(s) into the text box.

Comments

[Karim Keshavjee]

For those who are starting out on the journey toward implementing EMR, you will find some reports on the COMPETE (computerization of medical practices for the enhancement of therapeutic effectiveness) study at www.compete-study.com, in the publications section.

I have also recently developed some self-paced tutorials for ABELSoft Corporation. You are welcome to call them or visit their website and request these tutorials.

[Stephen McLaren]

New Users - oft heard but more often overlooked advice .. Read The Manual! In fact, Read the Manual before the final purchase offer is signed. Also, "Read the Manual Backwards" which means turn to the back of the manual where you usually find the troubleshooting section and system setup and sytem options. Then read it from page one onward. Use the knowledge gained to optimize setup and defaults parameters for your clinic. Having read the manual, ask yourself if the software does what you NEED it to do? ... and then ... read the manual ... for printers, PC's and other hardware. You may be surprised at nuances that can make your implementation a success.

[David Woolliscroft]

Tablet computing tips.

I firmly believe (hope) that the tablet will become the standard interface for the EMR in a primary care setting. Despite the problems with the first generation devices (e.g. we used the Compaq TC100 and will be changing shortly) I have found the tablet to be very successful. I work out of several exam rooms and as such, if I had desktops I would have to log in/out constantly for security and I would also be concerned about sticky fingers playing with it or indeed stealing it. In my case I carry the tablet with me virtually all the time and the only time it is set down it is secure and attached to its charger. Another advantage is I only have to have one tablet, set of hardware, upgrades etc.
I am hoping the Microsoft upgrade promised for the summer will improve the handwriting recognition, however I have learnt to improve my writing to take advantage of the system.

Some useful tips.

Internal wireless LAN cards are generally ineffective, slow and have poor range. You will probably need to upgrade to a wireless card 8011b/g.

Set the ink thickness to as thin as possible (options on the writing input area).

Dont bother with the text preview.

I tend to use a short delay befor it puts the text into the application.

Calibrate once a day preferably.

I know there are 'questions' about pre formed phrases, but I use the a lot and edit them at the time I insert the text. For example we all look at a patient when we enter the room and assess them for fever, cyanosis, dehaydration etc. I have a phrase that states I have done this, I just add modifiers like none, moderate, severe etc.

My EMR allows us to design templates which I use to maximise the efficiency of the tablet. We can use tick boxes for yes/no questions, Drop down lists and radio buttons for multiple answers - eg smoking never, current, ex etc.

We can also use templates to guide decision making and remind us of salient points - Am I the only one who has forgotten to write down the BP in a hypertension review?

I would be interested if anyone else has any tips.

[Alan Brookstone]

David, have you tried the Ablet Factory Vocabulary? I downloaded and used the medical SPID vocabulary with their Word Manager application. Significantly improved the handwriting recognition. It can even recognize words such as Diphyllobothrium Latum.

[Yves Raymond]

I have seen many EMRs in the last 3 years and can honestly say that they all pretty much look the same when they show them off. We often have questions like "Can it do this...How do you do that...." And most of them will be able to answer yes to most/all your questions.

What our group decided to do was to setup some workflow scenarios that are common day to day tasks that we do. We gave these to the vendor and we asked them to show us the entire workflow from beginning to end without asking any other question. We wanted to see the workflow that would occur between an MD, a Nurse and the receptionists concerning a patient in the office, phoning in etc...

This gives us a pretty good idea of how things flow within the program and you can see if it matches your style.

A few things I noted on most EMRs is the inability to see messages easily while writing a progress note, while filling out prescriptions and while filling out requisitions.

Another thing I noticed is that while filling out a blood work requisition, you couldn't see the CPP which shows, medications, PMH. This in my eyes is a big flaw since you order blood work based on age, sex, PMH, and medications taken.

Frequently, EMR vendors will point out that a certain piece of information is just a click away (in another window), but this will slow you down quite a bit over the course of a day, especially if you do it 40 times a day. This may even cost you an extra patient visit per day.

Designing a workflow for a particular task enables you to see how much time it takes to do a particular thing. We have even considered time trials but decided to forego this due to the many variables including operator and office work habits.

[Dale Taylor]

I agree with Yves Raymond that workflow efficiency is so important with EMR's. The fewer mouse clicks and the fewer times a doctor has to switch screens can make a big difference with how fast we can complete a chart. Having to resize a screen each time you write a prescription or move a screen so you can see information needed to complete a task wastes time. Programmers need to watch doctors using their programs and attempt to eliminate unnecessary steps.