Reddy Biggs' - The EMR in Practice with eClinicalWorks

I am not a vendor, but a 'real world' user. I don't work for any of the EMR companies. My goal is to demonstrate advantages to our practices that don't exist in the paper world. You will see improvements in quality, efficiency, cost and patient satisfaction IF you implement your EMR to its fullest advantage. 

A little about our background. We are a 20 physician + 3 nurse practitioner group practice in Internal Medicine with the subspecialities of nephrology, endocrinology, rheumatology, pulmonary and infectious diseases. We are using eClinicalWorks for both practice management and EMR. Our in-house lab uses Antek LabDaq which is interfaced with eClinicalWorks via an HL-7 interface. We are looking for a PACS system with computerized radiology (CR) as well, more about that as it 'develops'. 

What you see here is possible with any size group, and I hope it will give you ideas about what is possible with an EMR.

Reddy

Digital electrocardiograms - acquisition and storage

It's 2am, and you are seeing your patient in the ER with chest pain. It would really be nice to be able to compare the current ECG with a prior one. Is this really coronary ischemia, or is this from the 'Enchilada Special' at Fidel's?

Since we incorporate ECG's into our EMR, we can now view them remotely from the hospital. In addition, the digital ECG software allows us to compare tracings by superimposing previous studies on the one today.

Other benefits are immediately obvious. Instant sharing anywhere within you EMR network, no more buying expensive thermal paper that fades out over a few years, and an EKG device that is the size of your palm and weighs about 8 ounces. No more EKG carts blocking your hallway....we keep our MidMark unit in a drawer and plug it into the USB port on either a tablet PC, or a desktop if there is one in the exam room. We only need one ECG for lots of exam rooms, since the process is really fast.

5:00  Published April 24, 2008

For best resolution click on this link -->   http://www.youtube.com/watch?v=oQYM_ONirzs&fmt=18 

Reddy  April 24, 2008

For our patients: How to use the Patient Portal

Using the patient portal is really quite intuitive. But when you are dealing with large numbers of patients, some of them elderly with little computer expertise, you will  find that your office sometimes needs to do a little 'hand holding'. We created this video for our patients to watch prior to logging into the portal for the first time. 

Time: 5:42 Published 2/2/2008 

For best resolution click on this link -->   http://www.youtube.com/watch?v=Oqf2vWCQhHQ&fmt=18 

[YouTube:Oqf2vWCQhHQ]

Labs 1 - How to order them quickly and easily  and

Labs 2 - Reviewing, printing, faxing results, how they look in the chart & patient portal

Our lab ordering and resulting process has saved us an enormous amount of time. We have an in-house lab. Previously we printed out reports, they were sorted, routed, and the doctor could see them late that day or more likely the next day. Usually the doctor would devote several minutes of time after seeing patients to look at lab reports. The process is now radically changed. The doctor orders the test on his/her tablet, and the request is transmitted to the lab information system (LIS). The LIS then prints barcodes for the samples and sends the requests on to our lab equipment. As soon as the test is finished and reviewed by the tech, it is resulted back to eClincalWorks. The doctor gets a notifcation when the 'L" button on the dashboard lights up....yellow for normal results or red for abnormal results. Since there is no paper printing, sorting, routing, or delivery this happens quickly. It is very easy for the doctor to review the results in a matter of seconds, so they can do it between patients quite easily. We have about 1/2 of our lab results back on our morning patients before we go to lunch. This makes the review process go very quickly, since we more easily recall the patient, having seen them only a matter of minutes earlier.

eCW is like a lot of contemporary software, there are 4 or 5 ways to do everything.  Video 1 demonstrates some of these multiple ways to order labs. You don't have to do all of them! Pick your favorite....

In Video 2, we see the process involved in efficiently reviewing labs. They come back all day, and light up a jellybean labeled 'L'. I tap on that jelly bean to start looking at labs. From there I can do lots of things....simply file them away, print them, fax them, put comments on them. I show what the progress note looks like when the labs return, and what the patient sees in the lab section of the Patient Portal. 

Labs 1 Time 3:32 Published 1/12/2008

For best resolution click on this link --> http://www.youtube.com/watch?v=zfGrGWAxR8I&fmt=18

 [YouTube:zfGrGWAxR8I]

Labs 2 Time 6:14 Published 1/17/2008

For best resolution click on this link --> http://www.youtube.com/watch?v=pQGf6G0mr38&fmt=18

[YouTube:pQGf6G0mr38]

Printing, Faxing, and ePrescribing Options

I get a lot of questions about prescription writing. How easy is it?  

Keeping track of your prescriptions is a HUGE advantage of an EMR. They are all there, easy to find, and keeping the current med list is easier. Now when that patient comes in whose insurance changed and they want all 13 drugs refilled, we say NO PROBLEM. 

This example was designed for those who are curious as to exactly how fast the process is. Veteran EMR users already know how easy it is for them to print or fax. I've included an example of e-prescribing via SureScripts and included one actual refill so you can see what is involved. IMHO, refills on SureScripts are so, so, so much easier than paper or even fax.  

I don't show the technical details on our faxserver, some day I'll make a video of that if there is any interest. The faxes are sent to a FaxMan server. The software and installation were part of the eCW package, we supplied a Windows XP computer and faxmodem board as the 'faxserver'.  The faxes go directly to the fax unit, and get faxed. We have plently of phone lines for this task, so it usually takes only 1 - 5 minutes for the pharmacy to have the fax in hand. The whole process is transparent to the doctors/users. As far as they can tell, the task is done. If the fax fails to complete, they get an urgent message in their inbox advising them that the fax didn't go. We have all our pharmacies pre-loaded, so it is rare for this to happen, unless their fax machine is broken or out of paper. We now fax up to 400 prescriptions and consult notes outbound per day, and receive about 300 inbound faxes per day to our faxserver.

 Time: 5:11  Published 12/24/2007

 For best resolution click on this link -->  http://www.youtube.com/watch?v=XcNGLscEWOs&fmt=18

 [YouTube:XcNGLscEWOs]

Using ‘Inkable’ forms on a Tablet PC 

Do you find yourself still filling out some forms on paper in your ‘paperless’ office?

Despite our goal to do away with paper, other people still need paper. For instance, one local employer insists on a work release on their form, the license plate people want the disabled person license plates  on their form, and the hospital wants written orders on their form.We give them their forms!  We have them stored in our EMR to be used on demand. Even better, we don’t actually write on paper, we write on our tablets, print out the form (or fax it from the Tablet PC), and store the form in the EMR for future reference.

Time: 4:30 Published 12/22/2007