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A Family Physician's EMR Experience

I have always looked at technology for opportunities to improve the quality of care and the efficiency of my family practice. For instance, nearly 20 years ago I started using speech recognition software to dictate all my patient notes. This eliminated the high cost of transcription and turnaround time too. However since introducing an Electronic Medical Records system (EMR) in my office about 7 months ago the quality of care and the efficiency of my practice have vastly improved. EMR immediately brings many benefits to mind. There is an obvious decrease in paper use. Even faxes such as physician correspondence and reports are now received in a digital file which can be saved to the patient's record without printing. Prescription refill requests from pharmacies are now received, reviewed and filled electronically. Most of my patient lab test results too are now received electronically, reviewed and then saved into the patient's record, again without printing. But perhaps one overlooked major advantage of EMR is that data is now more commonly stored on a server offsite on the internet, "the cloud" which provides tremendous advantages.

Over the years I have covered my solo family practice 24/7, essentially 12 months a year. Even when I took a brief vacation or extended weekend out of town I relied heavily on cellular phone and hospitalists for coverage. This has mostly worked well over the years except that when I returned to the office I was confronted with tall stacks of charts waiting for messages to be signed off, reports and specialist correspondence to be reviewed. In fact over the years my brief vacations have been mostly work deferred. I paid for it with extra work when I returned to the office.

Things are now much different over the last few months. A brief story is perhaps the best way to explain some of the benefits of my EMR. Recently I had to make a sudden trip to South America for a funeral. Besides the obvious emotional distress, I worried about my practice coverage while overseas. I still had a hospitalist covering me for hospital cases. However, I was anxious that a local family physician would not be able to effectively cover other routine issues with patients whom she was not acquainted.  The EMR circumvented many of my worries. Because the software and data storage are Internet-based, my laptop essentially provided me with all the functions as if I were in the office. The main thing lacking is that I cannot examine the patient in person. From the time I reached the departing airport I was able to start reviewing my prescription refill requests, all fax communications, lab reports and all phone call messages documented by my staff. While in South America I also logged into my EMR software in the morning and at night and performed those tasks. For emergency communications my office was able to contact me by text messaging. When I returned to the office after this 'hurricane' 5 day trip I was relieved to see that there were no stacks of charts waiting for my attention, and because of the ability to seamlessly perform work on the road, I did not have any backlog of work on my computer/EMR system. What was stunning is that even though a family physician was backing up my practice, she did not have to be contacted even once! My competent staff and the EMR system worked wonderfully.

A high-quality state-of-the-art EMR system is very expensive. However, I feel that the benefits outlined above do make the investment worthwhile. The American Recovery and Reinvestment Act (ARRA) in 2009 allocated roughly $20 billion to promote the adoption of Health Information Technology (HIT). The government does reimburse you for the cost of the system if meaningful use is demonstrated.  According to a recent bulletin from the American Academy of Family Physicians, “Eligible professionals participating in Medicare can receive as much as $44,000 during a five-year period and as much as $63,750 if they participate in Medicaid during the next six years. CMS expects to start issuing Medicare EHR incentive payments in May 2011.”

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