The purpose of this page is to freely discuss
issues in pediatrics or our practice with a more personal perspective.
It is a place where the word "I" is permitted. Some of the information
will be factual and at times purely opinion. I might even sneak
in a bit of humor. additional
thought and sometimes humor to the practice of pediatrics.
WELCOME TO THE FUTURE
Pediatric Specialists took a giant leap into the new millennium
and the new standards of medical documentation when, on November
8, 2005, it officially began implementation of electronic medical
records. For one who has been so steeped in the paper document
this new challenge was both intriguing and frightening.
Electronic records quite simply mean that all
records of visits, exams, immunization, demographics, allergies,
medications, history, both personal and family, and even referral
letters would all be stored as electronic documents in a computer
something reassuring about having
that paper document but this is the future and we need to get over these
fears. We have lived with electronic files for years with our practice
management system which keeps all our demographic and insurance
information on each patient as well as all visits coded for purposes
of submission to third party providers. We have dealt with glitches
in this system but always we have been able to retrieve our information.
So why do we fuss over this electronic medical record (EMR)?
There’s something sacrosanct about a medical visit. It
has history, details about the exam and formulated ideas about
the interpretation of that exam. It sits in the chart as a document
that one can refer to in the future. But what are the drawbacks
of this system? The notes may be in the chart but after a chart
reaches a certain size one must shuffle through many pages to
find a particular visit. In trying to document a child’s
history of ear infections it can take much time to find all the
occurrences. Handwriting can also be a major obstacle in trying
to decipher a record. As much as we try some have handwriting that
is, to be generous, cryptic. What happens when the doctor is at
home and gets a call from a patient who was seen earlier in the
day or even in the past week and has questions about the visit
or instructions given during that visit? Unless the doctor on call
actually saw the child the vital information lies in the paper
record in the office. How about being on call and sending off a
prescription for a child while both parent and provider forgot
that the child is allergic to a particular medication? It can happen
and again the vital information is in the child’s paper record.
Enter the EMR. All notes are now permanently organized chronologically.
They are totally legible. All problems are well documented in a
separate list and all medications your child has ever been prescribed
are also listed. Allergies are listed prominently. All prescriptions
are written through the EMR and are electronically faxed to your
pharmacy. No problems with the pharmacist having to decipher handwriting
as these are all neatly typed. If a provider tries to write for
a medication that your child is allergic to the system will immediately
give a warning and block this action unless the provider enters
information to purposely override the warning (such as a child
who is no longer allergic to a medication). That nighttime call
now becomes much more effective as the provider can look at the
child’s chart from home and see any previous visits. The
provider can also leave a note regarding your call for the child’s
regular physician to view the next time he/she logs into the EMR.
Is this better medicine? You bet it is. And that is why the insurance
companies and large employers are strongly urging the adoption
of this program.
Pediatric Specialists is using the Longitudinal Medical Record
(LMR) which is the EMR developed and used by the Partners Community
Healthcare (PCHI). As members of Affiliated Pediatric Practices
which is a part of the Partners Community Healthcare network, Pediatric
Specialists was fortunate to be able to select this EMR option
. This same EMR is used at Massachusetts General Hospital, Brigham
and Women’s, Newton Wellesley and Mass Eye and Ear just to
name a few. Any of our patients who are seen for referrals or testing
in these institutions will automatically have any record from those
institutions included in their electronic record. Some labs will
also be adding their results to your child’s record. For
those referral sources not on the LMR , we will be scanning all
referral letters into your child’s record.
This whole process has evolved over the past six months with
the initial investigation of options for both the actual EMR, hardware,
methods to access the EMR and much training. As this new method
of documentation is mastered you might see some frustration as
well as a little slower pace. I myself find I have to develop a
new method of interaction in the exam room as the computer makes
some of my routines more difficult. I find myself making sure (as
opposed to automatic) I make plenty of eye contact in the exam
room. Things have gotten easier in the time since we started this
new venture. It’s getting better every day. This is the future
and we are bringing new technology to our patients which should
translate into better medical care. We hope they will be better
for it. Just one more giant leap for mankind.