Friday, August 22, 2008

All-Access Pass

Since my last post, I've continued my trial of's secure messaging system. I've signed up 27 patients and receive 1-2 messages per day. Several patients have written that they think this is a great way to communicate. My impression is that all the questions I've received would have warranted phone calls or office visits if electronic messaging was not available.

I like the option for asynchronous, or time-shifted, communication. If I have calls to return, I either make the call before I leave the office, or it waits until the next day. With electronic communication, I can leave the office on time to see my son's soccer game, and then deal with emails later in the evening.

I currently have a patient who had to travel very soon after having a biopsy done. I'm planning to use electronic messaging to let him know about his results. Playing phone tag with someone on a different continent would be very frustrating.

It's also easy to cut-and-paste the messages from into our electronic chart, so I don't have to make additional notes, like I would for a phone call.

There are some negative aspects to electronic messaging. There's no way to pick up on the sometimes-subtle emotional cues you get over the phone.  I wouldn't want to break bad news this way.

Some of the exchanges I've had could have been dealt with better on the phone. The site already has a notice telling patients to call their doctor for emergencies. Also, some complicated discussions about multiple treatment options are more appropriately handled with a live conversation.

There are plenty of people who don't have internet access, or who are just not comfortable with communicating this way. I wouldn't force this option on them.

Friday, August 8, 2008

Tech Talk

In this age of Google and iPhones, a colleague of mine is ostentatiously low-tech. He scrawls his to-do list on a pocket-sized notebook.  And takes a lot of ribbing for it.

I fancy myself at the other end of the tech spectrum.  I'm always watching for the latest device or application that will help me run my practice more effectively.  So whenever I see him squinting at the tiny writing in his notebook, I think:

Good for you!

He's got a system that works.  He reviews and updates his list regularly.  It's with him all day.  It's accessible, versatile and user-friendly.   It's not bloated with esoteric "features". 

I have other colleagues who say, "I have the latest PDA."  Which they leave at home because it's a hassle to carry it around. 

Contrast the $2 practice management tool with the $250 paperweight.  Information technology has huge potential to increase our practices' efficiency and improve the service we provide.  We each need to pick the tool that fits our style and needs.

And then use it!

The most significant technological Clinical Practice Redesign (CPR) change we've made in our practice was implementing an electronic medical record (EMR).  I've sung the praises of EMR before. We started computerizing the office over 20 years ago, but initially just used the system for appointments and billing. The physicians didn't have computers in their offices.  About 3 years ago, we decided to adopt an EMR.  It's been a slow process.