So you're ready to computerize. Are you going to build your electronic medical records system piece by piece or implement it all at once?
When it comes to the sea of computer technology, Peter Geerlofs, MD, of Port Townsend, WA, recommends wading in a step at a time. "This method reduces the culture shock inherent in moving too quickly towards the electronic patient record," he says.
He practiced rural family medicine for 14 years and later founded Medifor, a company dedicated to an incremental, modular approach to clinical computing, focusing first on patient education.
Many inexpensive features can offer big benefits. For example, drug interaction software is available for less than $250, Dr. Geerlofs says.
Converting to an electronic medical record incrementally may help the intimidated FP feel more comfortable with technology, says Dr. Geerlofs.
On the other hand, Todd Swanson, MD, clinical associate professor at the University of Wisconsin medical school's Eau Claire Family Practice Residency, reminds FPs that sometimes it's easier to take a deep breath and jump in.
He should know. In 1994, the residency went from paper charts and 13 computers to paperless charts, 60 computers, and a Novell network in six months. "It was fairly fast, but having a paperless EMRas the endpoint forced change to happen," Dr. Swanson says. "The electronic medical record requires everybody to become computer literate and change how they do things."
He suggests that family physicians planning to computerize do so over the course of a year. "If you put the whole electronic medical record in fairly quickly, you don't have to struggle with integrating different modules."
Dr. Swanson says a small group may have an easier time "jumping right in" than a large organization, which would probably have to phase in the system. What about the cost of the two approaches? "Eventually you need personal computers in the exam rooms, and that's half the cost," says Dr. Swanson. "Either way, it comes out about the same."
Regardless of which approach you take, your success depends on solid planning, says Randall Oates, MD, of Springdale, AR. "It's a re-engineering," he says. "Most obstacles can be anticipated and addressed long before you bring the system in."
He recommends budgeting as much or more for "peopleware" as you do for software and hardware. Build trust among the people who will be affected by the new system, involve all office personnel early in the decision process, and begin retraining. "Education, conferencing, getting the communication system in place so everyone can share their successes and frustrations--these are often overlooked," Dr. Oates says.
"Computers and Family Practice" contents
FP Report, July 1996 headlines
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