I left off describing some of the challenges of implementing an EMR for my optometry practice. I touched on issues relating to the conflicting perspectives of clinicians and managers, reasons and benefits for going electronic and the inherent problems associated with implementing such changes. I think I'll continue just where I left it... detailing some problems that arose during the transition.
I shamefully must admit that we still use paper. Our patients must provide us their information on carbon copy forms that will, at a later time, be interpreted and entered into the system (by me). This allows for problems related to illegible patient handwriting and unnecessary errors introduced in the data entry process. Furthermore, what I failed to mention previously yet has become a substantial problem is the wasted time lost during this redundant process. Although a good problem to have, when the office is busy, the weekends are spent 'catching up' on paper profiles. Its no fun at all!
Fortunately we are nearing the end of the "1st paper then computer" phase of our transition. I am nearly complete with the scripts that will allow patients to provide us with their profile, medical history and insurance information... all on the computer! An intelligent, adaptive script was created to ask only the pertinent questions. If you don't wear contacts, you won't have to answer any contact related questions. If you have diabetes, be prepared to provide a lengthy medical and treatment history. All of this will occur on a new workstation that is already up and running, currently used as a terminal for content lens training videos or for playing Disney movies to entertain the awaiting guests. The workstation is connected to our LAN wirelessly, which communicates to our server hosted remotely and all data is available in real time. Yes, I'm fairly proud. But its not done yet... but I just can't wait until it is. I'm so very tired of paper profiles.
Whats next? Plenty. I cannot express how vitally important it is to carefully plan and collaborate with the clinical staff every detail pertaining to workflow and interface for an EMR solution. The old adage that states, "measure twice cut once" comes to mind. In developing software, its better to know exactly what the end result should be and WHY, before you code. Coding is the VERY last step. You really just want to do it once. Imagine building a house and then find out you need to change the bricks in the foundation. If you're sensing a bit of regretfulness in my words, it is because I have learned this lesson the hard way. Now that we are nearly at our goal of a paperless office, I've just realized something profound. My software could be so much better.
Indeed, it can always be better. But a little more time spent investigating and planning can go a long way in producing solutions that have longer life spans, be more beneficial, and can save you lots of time and money. In my case... essentially everything has gone electronic. Our appointments are now fully web based. All invoicing and billing is electronic. My wife records anything via a computer with 22" LCD monitor... using mouse and keyboard, just as I had envisioned it. But therein lies the problem, the computer system in the exam room.
Prior to this transition, there was no patient-doctor-computer triangle. My wife seldomly had to turn away from her patient. There wasn't any real distraction or interruption in the work flow. But now, due to the improvements of technology, my optometrist must neglect her patient to interface with my computer system. I once heard that, "its not a problem until there is a solution." Well, its a problem now because there is a solution... has been for a while. They are called "Slates" and are revolutionizing how clinicians carry out their tasks. Slates are essentially super thin computers the size of a traditional laptop screens. There is no keyboard. Interface is via finger touch or digitizer pen, or both. To be effective however, slates must run special software that takes advantage of this unique interface. Ah... special software... there goes the weekends again.
If you've ever used an Apple iPhone or any touch screen device, you will immediately find the interface to be intuitive and refreshing. It just makes sense. My little 2 year old cousin plays a basketball game from my iPhone... he learned how to do it in all of 3 seconds. One major obstacle that EMR or any software tends to have are problems with the interface. When restricted to inputs such as mice and keyboards, inputting becomes unnatural. Its not the fault of the programmer, he's doing his best. Likewise, its not the fault of the computer either, it doesn't care how you interface with it, it just needs input to do its job. Slates, such as the newly introduced Apple iPad, can change all that. The computer gets its input without a keyboard or mouse, doesn't require the clinician to turn his/her back to the patient and may effectively eliminate that scandalous triangle that tried to wreck our happy home. Cool! Great! Lets go buy a slate and we're done... or are we?
Nope, not even close. As I said before, to be effective, slates have to have customized software to make them useful. Just as trading pen and paper for keyboard and screen in and of itself is a hollow achievement, further swapping the keyboard and mouse out for a touchscreen can realize only minor improvements. Yes, we can the triangle. And yes, we save space and the clinicians look real cool doing what they do. But are they faster? Will they be more efficient? Are they having fun? My tests on my Lenovo x60 Tablet with my existing EMR solution proved only slightly better. I am now challenged to create a new interface that can really take advantage of touch input. Here are some of the problems I can already foresee with slates.
1.) Big fingered people will experience difficulty with accuracy with touch interfaces.
2.) Fewer available options... (1 finger VS 101key keyboards and 3 button mice)
3.) How to type when you need to type. (Virtual onscreen keyboards provide no tactile feedback)
4.) Slates are lower powered and often limited. (iPad OS isn't multitasking, built in browser... Safari, does not render Flash)
5.) Battery power is limited
6.) Its really cool, so people will want to steal it.
As there are always challenges in any change, there are also benefits. I feel I have not done justice to the idea here. EMR solutions are good things! They are intended to improve the circumstances and I will tell you, I won't ever go back to paper. I'll close this entry with a positive note that addresses the title of this blog... "The Best EMR Solution: In-House" Why in house? One reason is this... turn around time on updates, large or small, is really limited to how fast your in-house IT department can produce them. In this case, I'll say about 15 weekends.
to be continued.
