The following is a guest blog by James T. Loynes, MD. During a recent call he told me about an EMR he wrote for his oncology practice. My initial thought was, “Just what we need, another EMR.” The more I listened, the more I thought he had something different, something that actually was built towards an eye for best practices. I asked him if he would tell you about it. The rest of this is his.
The Path to Excellence Is Under Construction
James T. Loynes, MD
No really, I am not crazy. I just want to do things better. That’s the reason I built my own EMR. I worked with an excellent group of programmers to design my Hematology-Oncology EMR piece by piece over a period of three years. I fixed every design flaw and mistake. Problem by problem I made it right.
It wasn’t easy and it wasn’t quick. I examined how I care for patients. I evaluated how paper and information flowed through my office. I met with nurses, secretaries and transcriptionists to determine how we could do things better. I knew that technology could be a powerful tool to improve patient care.
Even as a medical student, I never understood why it was so hard to find patient information. Charts could be lost or misplaced. Medication lists were always a moving target. Why couldn’t we use technology to make things easier and more efficient? I was annoyed that I had to dictate the exact same information visit after visit. I was consistently slowed down because I had to find and repeat documentation.
I listened to stories from patients about other physicians who spent entire visits looking at the computer screen because that is what their EMR demanded. I saw EMR generated notes that had so much information that it was difficult to read. I made it a point to avoid these pitfalls.
I needed my EMR to make me better, smarter, and faster. Since there was not an oncology EMR available that filled my needs, I built my own. I started by designing a web based program that helped me with my chemo orders. I designed it to fit my (physician) needs. I wanted to be more efficient. I wanted to take better care of patients. I wanted to be able to find information when I need it.
I like paper! I know this is EMR blasphemy, so don’t tell anyone. I can write on it, put it in my pocket, or give it to someone. It is easy to read and anyone can use it! You know what else I can do with paper? I can throw it away or recycle it. While I like paper, I don’t like to file or find it. As we all know, maintaining a paper chart demands a huge amount of work. A tremendous amount of time is spent finding, carrying, copying, thinning, and building a paper chart. I decided that I need paper, but I wanted my EMR to get rid of the paper chart by electronically putting paper where I can find it on demand.
My EMR is web based. I can access it with any computer that has internet access. The system can support one physician or fifty. I have hundreds of templates that I can easily edit. I have order templates, note templates, chemo templates, and nursing templates. The system automatically fills in designated portions of the physician notes. The EMR remembers information from previous notes and places in a manner that allows me to dictate new information only. Dictation time and expenses are dramatically reduced. Treatment calendars accurately track chemotherapy dates and cycles. The nurses can write phone notes, enter vitals, and document core nursing measures. They can perform medication reconciliation and take verbal orders. I can easily monitor my billing codes and keep track of information needed for the ASCO Quality Oncology Practice Initiative. I can build treatment plans and treatment summaries. The system monitors chart access. Preliminary notes or chemotherapy orders prep the EMR for improved productivity. Patient lists speed up chart access. Medications lists and visit summaries can be printed on demand.
This EMR could be easily altered to accommodate different practice specialties. What would happen if you had 30 physicians in the same community using this web based EMR? Providers at a small practice have access to the same technology as the largest practice. Instead of 30 different methods of documentation, each provider could use the same system. There would be nothing to download and very little equipment would be needed. Communication would improve exponentially. The whole community would save on medical costs because there would be less duplication of efforts. The work of others could be viewed by all. In the end, everyone benefits, and patients receive better patient care through the use of technology. Alright, maybe I am a little crazy, but sometimes that’s what it takes.
I applaud any physician that writes their own EMR. In fact one of our major shareholders is a physician that did exactly that. He then joined up with us to make our product better, and give us a perspective, and someone to bounce ideas off.
I like working with physicians that have programmed for themselves – especially an EMR.
In Canada the ability for physicians to do this will likely be taken away through the Medical Device Level II requirement. This rule does not make it impossible, but it does make the barrier to doing so higher. It is not an inexpensive process to go through. Our company went through ISO certification back in 2004. This is yet another one to go through.
I like to see innovation, and creativity. Letting as many people write EMRs and use them is what will drive the industry to be better.
Credit to Dr Loynes, Not a easy task.