letters

Optimizing vaccine administration

I would like to commend Dr. Barry L. Hainer on his article "Vaccine Administration: Making the Process More Efficient in Your Practice" [March 2007]. I agree with Dr. Hainer's excellent recommendations for improving the immunization process in doctors' offices; however, the article did not mention the importance of vaccinations for a practice's staff members.

I recently read that only 40 percent of U.S. health care workers are vaccinated against influenza each year.1 A successful vaccine administration program should educate staff members on the benefits of vaccines. Staff members should know that vaccinations not only protect them from disease but also significantly reduce their risk of transmitting infectious agents such as the influenza virus to patients, other staff members, family members and the general public. Furthermore, vaccinated staff members are uniquely qualified to encourage patients to receive immunizations because they can explain the benefits firsthand.

I would like to suggest an excellent vaccine resource. Control of Communicable Diseases Manual, 18th edition, published by the American Public Health Association, provides health care professionals valuable information on infectious diseases and includes descriptions of vaccine-preventable diseases, vaccine availability and immunization schedules. The manual is compact and easy to use as a reference guide. It also contains sections about reporting communicable diseases and the proper response to bioterrorism and biological warfare.

Christian T. K.-H. Stadtländer, PhD, MPH, MBA
St. Paul, Minn.

1. Health workers target of new guidelines on influenza shots: most workers fail to get annual flu shots. The Nation's Health. April 2006:1,20.

Maximizing workflow with an EHR

Dr. David E. Trachtenbarg's article "EHRs Fix Everything - and Nine Other Myths" [March 2007] describes ways to address the shortcomings of electronic health record (EHR) systems. Physicians should also understand that the implementation of an EHR creates an opportunity to optimize workflow.

With paper charts, physicians typically perform most, if not all, of the documentation of patient encounters. With EHRs, physicians can continue to be the primary author of all documentation if they choose, or they can implement a team approach to record keeping if their EHR is well constructed. A good EHR provides templates and flexibility to combine discrete data entry with free text.

EHRs are often marketed as being simple and streamlined with structured templates for a variety of medical conditions (e.g., hypertension and diabetes). Ironically, with the exception of some acute visits, the typical office visit of a family physician is neither simple nor streamlined. It often includes managing multiple chronic conditions, preventive care and acute problems, and it is rarely a one-problem visit.

When our group transitioned to an EHR, my greatest frustration was feeling constrained by these templates. Once I let go of this frustration, my EHR-induced anxiety waned. I began to focus on how my staff team and our EHR could optimize the care I provide my patients.

There are numerous permutations possible. I huddle with my staff before seeing patients each day to review the schedule and determine which encounters will have a coordinating EHR template. Our medical assistant collects the preliminary information at the beginning of each patient visit, which I review before entering the exam room, and then I clarify and confirm the information during my patient interview. The assistant accompanies me in the exam room and records the encounter.

This workflow process has been liberating. I spend my time focused on the patient, not distracted by documentation or the computer. My patients seem to appreciate the improved cycle time and don't mind having an assistant present. By the time I leave the room, most of the documentation is completed.

The success of this model is highly staff dependent. With team documentation and the tools nested in the EHR, I am able to more effectively provide comprehensive and quality patient care.

Sonja Van Hala, MD, MPH
Salt Lake City

Saving the best for last

Hats off to Jack Valancy, MBA, for his wisdom in saying what needs to be said and having the courage to say it in "Health Care's Giant Hairball" [The Last Word, April 2007]. Thanks, Jack, for supporting physicians and giving all of us a reality check.

Judy Capko
Thousand Oaks, Calif.