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.

We started with a couple of self-identified enthusiasts, and began computer entry of all of our consultation notes, as well as lab, x-ray and pathology results.  Suffice to say, it's a huge improvement over paper charts.  Staff no longer had to pull charts for patient appointments, track down misplaced files and create new folders for each new patient. 

We've gradually expanded the number of doctors who are "paper-less".  Two new doctors have joined us over the last 2 years, and they've been fully EMR from the day they started.  We still have 3 doctors to incorporate into the EMR system, and plan to complete this over the next year.

Our EMR vendor underwent several corporate takeovers, and we're currently up in the air about which vendor we'll be selecting to replace them.  There's no standard national EMR system, making it difficult to integrate all parts of the healthcare system.

And that's where the big payoff for EMR will be - integration.  We need the family physician's EMR to talk to ours so we don't waste physician and patient time asking questions about medical history and medications, when the information already exists somewhere else.  We need the hospital lab to send us results directly into our computers, rather than faxing them to us.

Another advantage of our office EMR has been remote access to patient records.  The world's slickest EMR doesn't do me any good if I'm at the hospital and it's at my office.  Remote access lets me review patient records from any place where I have internet access.  I can pick up messages from my staff, return calls, and review lab results in downtime between surgeries, rather than letting the work pile up during the day.  I can also choose to time-shift my work.  Rather than staying late at the office, I can get home for supper and review charts later in the evening, once my kids are in bed.

Wireless internet access and web-based applications have created a data cloud (like Pigpen's dust trail in the Peanuts cartoon strip) that follows us around.  Information isn't shackled to one computer's hard drive.  With the appropriate device, we can reach into that cloud wherever and whenever it suits us.   Google Calendar and Documents are great examples of applications that form the data cloud.

The latest application I'm trying out is electronic messaging with patients.  Phone tag is frustrating and time-wasting.  I've been interested to try email, but it's not confidential and private.  The CMA's practice management affiliate, Practice Solutions, is offering secure, password-protected electronic messaging through their mydoctor.ca Health Portal.  I've been trying it over the last 2 weeks, and although it needs some improvements, I think it has a lot of potential.

I've been offering access to patients who may need further information from me (especially those with a recent cancer diagnosis who are making decisions on treatment).  They give me their email address and it, along with their name and birthdate, on the mydoctor.ca system.  They receive an email inviting them to create a username and password.  After that, we can message back and forth in private.  Any new message on the secure system triggers and email notification to the recipient, but the email doesn't contain any confidential information.

At the moment, mydoctor.ca messaging has a beta feel to it.  They need to add the ability for clinic staff (rather than just physicians) to enter patients onto the system, as well as a way to check if patients have opened messages I've sent them.  I would also like the system to let patients know there is a message from me, even if they haven't yet created a password for access.  I also suggest the capability for a "holiday message" telling patients I'm away from the office, and not to expect a reply until I return.  The system administrator tells me these improvements are planned for the early fall.

When we've discussed using email with our patients, one of the physicians' concerns was the possibility of being bombarded with messages.  We wondered whether some Internet-involved patients might fire off email questions for any urology-related thought that came to mind.  Currently, our staff screen calls and handle many questions related to administrative matters.  If we give direct email access to our patients, perhaps we'd be stuck managing those issues (or at least, having to forward them along to our staff).

However, most of the reports that I've read about physicians using email for patient communication say that this rarely happens.  In fact, doctors comment that patients are usually exceedingly conscious and respectful of physicians' time and don't send frivolous emails.

When I decided to try this service, one of the first patients I considered signing up was someone I'd been playing phone tag with for several weeks.  He was in the middle of a difficult decision about cancer treatment.  However, after receiving a few multi-page faxes from him and his wife, I had second thoughts about offering electronic communication, for the reasons noted above.  But, what better chance to test whether patients would "overuse" this service?  So, I signed him up.

In the very first exchange, his wife wrote, "I promise not to abuse the privilege of this email access." 

I have my answer.  I won't hesitate to offer this access to anyone else.