Electronic health records; its all in the tech.
My transition to EHR is well underway. I elected to try the EHR in Eclipse, even though it was not the fanciest or the easiest looking system, however, it made sense to at least try what I had without making things too complicated. My system is Eclipse, which is a server based system which is old school accounting and has a great interface for billing and accounting.
Without knowing what to expect, I watched their videos, customized their encounter program and found that I could create templates that work the way I currently do, except the notes can be in far greater detail and I can continue using my Problem Orientated Medical Record (POMR) which allows me to establish medical necessity much better than a typical soap note.
At first, I tested all my technology and made up a couple of dummy patient files to test my templates for different conditions to make sure they worked and gave me the note that would satisfy medicare and other carriers. While I am still tweaking this, so far I am satisfied with the quality of the note, while developing a system that allows me to work as I always did, and finish my note before I finish the office visit. The only note that cannot be done this way is an initial one, as in a new patient or an update. Those notes are finished later in that day and take just a little more time than they used to.
Once I tested my tech which included the following:
1. For my home office, I installed a new computer with a 23 inch screen which relies on a mouse for input. I can log into my main office server and conduct my affairs as if I am in the main office. I can also do my incomplete notes and any other work from my home. I began using logmein which works reasonably well other than its ridiculously slow refresh rate. A friend of mine showed me how to log in using remote desktop which is much faster and better. The problem is that occasionally, I will log in, and not connect, because Verizon sometimes changes the IP address. It is good to have logmein as a backup just in case and if that does happen (it did once already), I can logmein and then go to a browser and type in whatismyip.com. Once I have that, I can then log in and it works well.
Obviously, this is not perfect, however, if the Internet goes down, an Internet based system will leave me stranded with paper and then the input headaches of being backed up so I like this better.
2. For my main office, I started with the computer network we had, and added a convertible laptop that separates into a 13 inch tablet and a keyboard via wi fi. I found this at the Microsoft store, which is a good place to see and play with technology to see if it meets your needs or solves a problem.
I needed to get a more powerful wifi booster for the office simply because a poor signal would cause load times to be poor. If you use a system like this, get a powerful wifi booster. There a quite a few of them on the market. Use Amazon because people rate the devices.
Initially, we began using this laptop which did the job however, I ran into problems with occasional load times and also using the mouse pad was bad ergonomically. While the laptop did have a touch interface, the reality of using it had some problems including;
a. Fingers were too big to use the touch screen since the menu’s and their interface is cryptic, and even using a pen type contact was too time consuming. Some of these input pens are cheap, but time is money and efficiency on a busy afternoon is priceless.
b, Using a mouse helps but still, time consuming when using the Eclipse Encounter interface.
c. When entering a treatment room, time is wasted opening the laptop, bringing up the patients name and waiting for them to load, while looking at the screen. My desire was to not be one of those doctors looking at the screen instead of the patient. The laptop idea, while cheaper, was definitely not the way to work in a busy office, especially if the wifi went down.
Rethinking my tech, plan B
After my first week of input, I began to realize that I needed a better solution. New patient input took a while, and it was easier to use my old paper system and then transfer the results later to the computers. Our exam room had a computer in it because of the digital xray software. Now, it doubles as a new patient input area as well.
I wished there was an all in one touch screen computer that could just be mounted on the wall. I visited Best Buy who had a bunch of these but it seemed, none of them were designed to wall mount except for one, the Dell all in one Inspiron. After texting with the Dell sales people, they said that these computers are wall mountable. I purchased a 20 inch version and found out that it had a non standard mount and was not wall mountable so be careful with Dells help desk. I returned a second one I purchased and used one of these in my third room which is the largest of the treatment rooms. Best Buy had the 23 inch version of this computer on sale which I confirmed had a VESA mount which is a standard for mounting computer monitors.
I purchased two of these for my first and second treatment rooms which are small. I installed them a week ago and they wall mount without a problem. If most doctors knew how their input could be sped up by large touch screens, they would never buy a laptop to go from room to room since you can mouse and touch simultaneously which saves input time and reduces the time necessary for notes.
It has been a week and we are now in our 6th week of EMR transition which is going relatively smoothly.
My new computers are all on wifi right now and will be on ethernet which I have my tech finally install the wiring into my network.
One last thing; if you do what I did, have a backup. I am keeping the laptop around just in case one of the computers develops a problem. Always have a plan B otherwise, your office could grind to a halt. Also, we are using carbonite to back up nightly. I have also just added a Western Digital backup drive as well that comes with backup software. You can never have too much protection.
Based on my experiences, I recommend the following to anyone converting to an EMR.
1. Whatever software you use (web based, server based) , do not skimp on good input devices. For any software, a larger touch screen is always better than a screen with a mouse only. Yes, I am showing some love for windows 8, which is actually good for this. I wish I had this for my home office.
2. Dells 23 inch all in one is fast and responsive with wi fi, and an I3 intel processor which is now on sale at best buy for under $700. These are nice touch computers with a disc drive (MRI discs) that is a time saver. Mounted to the wall, it is also a space saver too.
3. Always set up contingencies. What is your plan B if the computer in one of the rooms does not log in? The laptop of course, which has a solid state drive, so it boots fast.
4. While I am running these on wifi, ethernet is faster and more reliable.
5. Save time with every patient during a busy afternoon by having your staff put the patient in the room and have them open the EMR to the patients record so you can walk in, begin the conversation and concentrate on them, rather than the machine. The patient experience is more important, so the right tech will prevent the tech from being a distraction. The system you use should work as you do.