Letters

Priorities and strategies

To the Editor:

Your February 2001 issue was one of the most helpful ever. The self-test ["The Family Practice Management Practice Self-Test," page 41] not only revealed shortcomings in our practice but put them in the context of "how important is this to us?" The results enabled us to prioritize what might otherwise have seemed like a long, unrelated list of "should do's."

I feel no practice is too big or small to benefit from an annual meeting ["The Meeting You Won't Want to Miss: Annual Strategic Planning," page 28]. Our group of seven family doctors has done this for about 15 years, and it's well worth the investment of our time and energy. Each fall we have a two-day retreat, with physicians and the entire staff meeting on day one and physicians and spouses meeting on day two. Since we began actively eliciting staff input in this and other venues, our practice has become more innovative and energized. Including spouses in dialogue and decision making is essential. Most decisions made at the retreat affect finances and/or the schedule. These are family issues, and we find that our plans succeed when we all share in the process of defining our vision and setting our goals.

We appreciate FPM and find it to be inspirational and informative.

Elaine Brautigam
Westfield, NY

How secure is your palm-top?

To the Editor:

I'd like to add to "Using Your Palm-Top's Date Book as a Reminder System" [May 2001, page 50]. Once patient information is entered into a palm-top computer, confidentiality issues must be addressed. Although palm-tops have a locking security feature, the user must remember to activate it each time they want to secure their computer - making it unsuitable since no one can be expected to use it 100 percent of the time.

I recommend Sign-On (http://www.cic.com/products/signon; $19.99) or TealLock (http://www.tealpoint.com/softlock.htm; $16.95). Both programs enable users to program their palm-tops to automatically lock-out after a user-defined period of inactivity. Sign-On is simple to use, offering the ability to use your signature, initial or any other mark you choose as a method of "unlocking" your computer. TealLock has quite a few options using the on-screen buttons or number pad, but doesn't use a signature-based method to unlock the computer.

David B. Hill, MD
Davis, Calif.

Four tips for EMR integration

To the Editor:

My partner and I appreciated
Dr. Schenk's letter in your April 2001 issue ["The Other Side of the EMR Story"]. We both experienced a less-than-favorable introduction to electronic medical records (EMRs), and this was a major factor in causing us to break with our group.

We were part of a 20-physician group with four different sites. The group began using an EMR with all the bells and whistles - daily visit records, billing by physicians at the time of event, scheduling, prescription writing, messaging. You name it, it had it. Unfortunately, almost 11/2 years after implementation, the system still hadn't lived up to its promise. It crashed frequently - to the point that the group and EMR vendor now share the expense of keeping a troubleshooter on-site to take care of daily computer problems.

I have some suggestions for future EMR buyers:

• Decide what part of the EMR you want to start with (e.g., just the prescription portion). Familiarize yourself with each part before moving on to the next, and make sure all members of the staff are on board.
• Insist that the vendor provide decent training. Many of the trainers we had did not have the patience or ability to translate their advanced knowledge into simpler terms.
• Don't expect all group members to be equally enthusiastic at the beginning. Let those who are eager and familiar with computers be the first to use the EMR system, and then allow others to join in at their pace (this could take one to two years depending on the characteristics of the group). Be prepared to have dual systems of recording patient visits until everyone is comfortable with the EMR system.
• Get the billing system working first. Physicians don't want to lose revenue because the computer wasn't set up properly.

We will eventually use an EMR system again; it has distinct advantages over bulky records. But we won't be tripped up again by glib sales talk.

Walter D. Leventhal, MD
Summerville, S.C.

Correction

The article "What You Need to Know About HIPAA Now" [March 2001, page 43] incorrectly stated that small practices will have an additional year to comply with the Health Insurance Portability and Accountability Act's privacy regulations. The compliance date for the privacy regulations is April 2003 for all practices, regardless of size.

Copyright © 2001 by the American Academy of Family Physicians.
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