Welcome to EMR and HIPAA

EMR implementation must follow an important instruction from the movie “What About Bob.”

BABY STEPS!!

I divided our implementation into a bunch of phases for our health center. That way they would have time to learn things in a step by step manner rather than all at once. After we did the first phase they started asking why they couldn’t just do it all. It made me laugh since they were so averse to ANY additional “changes” at the beginning.

Today I trained one of our more computer averse users on another feature we started using. What would have taken me an hour to train in the beginning was easily trained in 10 minutes.

I told her, “That wasn’t so bad, was it?”
She responded, “It was one of the easier things I have learned.”

The reality is that it was actually more difficult than most of the other things she had learned, but her technical skill was now higher and so she was able to grasp new concepts much easier. I should note that a more tech savvy ma learned the new feature in 2 minutes.

This CCR Initiative seems to show some interesting promise and I’m very interested to look more into it. I’m not sure how HL7 and CCR will work together(or against each other), but I expect to see the CCR abbreviation to become commonplace with EMR’s.

Here’s some good info I got from this website:

Continuity of Care Record Is Developed by

ASTM International Health Care Informatics Committee

W. CONSHOHOCKEN, Pa., 5 January 2006—A revolutionary new ASTM International standard will change the way in which healthcare professionals preserve and transfer healthcare information about their patients. The standard, E 2369, Specification for Continuity of Care Record (CCR), was developed by Subcommittee E31.28 on Electronic Health Records, which is under the jurisdiction of Committee E31 on Healthcare Informatics.

The Continuity of Care Record is a core dataset to be sent to the next healthcare provider whenever a patient is referred, transferred, or otherwise uses different clinics, hospitals, or other providers. The CCR will bring an end to physicians and other healthcare professionals having to act “blindly,” without easy access to relevant patient information. It will provide the necessary information to support continuity of care, thus reducing medical errors, achieving higher efficiency, and creating better quality of care.

During the past two years, U.S. President George W. Bush has called for greater interoperability of electronic medical records and personal health records. E 2369 represents a major step forward in assisting vendors and healthcare organizations in their search for simple, yet powerful tools that will help meet the president’s objectives.

Read more…

I saw a really good survey about the technical systems that University Health Centers in the Sun Belt region are using. It covered Medical Clinic Systems, Electronic Medical Records, Appointments made by email and online, Pharmacy systems, Mental Health Systems, Wellness Education Systems(not many of these), Laboratory, Digital X-ray and Computer portals. I twas interesting to see the variety. In fact, there was a lot more variety than I would have expected. Pyramed seems to have a good Medical Clinic System(I assume this is appointments and billing probably) because so many University’s had it. This could also because it is only the Sunbelt region. Medicat seemed to have the most listed for EMR with a variety of other choices. QS/1 seems to be the pharmacy of choice.

I was a little disappointed that this was just a subset of the US. I would love to see a similar survey for the entire US. I also wish it was in excel rather than PDF, but that was even more important for the jobs part of the survey. Here’s a link to the tech report.

I found this article which described some of the feelings we’ve had in implementing an EMR. This article in the beginning highlights how a simple phone call has a great effect on the morale of the clinic and the need to relearn this process after implementing an EMR. I agree whole heartedly and even extend this same response and lack of morale throughout almost every single piece and process in the clinic. Every step that is taken before a patient arrives, how a patient gets checked in and processed through the clinic(not that patients are “processed” like computers) and even after the patient leaves has to be evaluated and decisions must be made on how everyone is going to function with a new EMR.

Here’s the start of the article:

From the January-February ACP Observer, copyright © 2006 by the American College of Physicians.

By Janet Colwell

At Greenhouse Internists in Philadelphia, getting patients’ phone messages to physicians used to be a fairly simple process. The receptionist would write the message down, pull the patient’s chart, clip the message to the chart and place them both on the doctor’s desk. The physician would record the conversation in the chart and then send it back to be filed.

Converting to an electronic health record (EHR), where all the physicians and staff would have simultaneous desktop access to everyone’s files, promised to make that process even easier. But after the office went live with an EHR in mid-2004, taking a phone message—along with every other office routine—became a source of missteps, errors and tension among the once-compatible staff.

At Greenhouse Internists in Philadelphia, Melissa G. Schiffman, ACP Member (left), and Richard J. Baron, FACP, discuss the best use of patient data recorded in their tablet laptops. The group implemented an electronic health records system in 2004.

“Just responding to a patient’s question or phone call became difficult,” said Richard J. Baron, FACP, one of the group’s four general internists. “Everyone had to do things differently, and no one knew exactly how to communicate with everyone else. How did the people taking the message communicate with the people in the file room if there wasn’t a piece of paper moving around? Where would the doctors look for information to support telephone decision-making?”

Read more…