Residents Hold Key to Future

If you want a glimpse of where family medicine is headed in the not-so-distant future, hang out with the next generation of FPs for a day. At the Trident Family Medicine Residency Program, residents recently told FP Report -- in no uncertain terms -- that they will settle for nothing less than electronic health records in their future practices.

The coverage in this issue -- part three in a series on the new model of care proposed in the Future of Family Medicine report -- shows how training residents with EHR technology will change the specialty of family medicine. You can access the report at http://www.annfammed.org/cgi/content/full/2/suppl_1/s3.

A stroll through the Trident clinic yielded residents eager to share their thoughts about how the information technology in place here has affected their ability to provide top-notch patient care, and ultimately to go out and find a job.

Third-year resident Rick Wall, M.D., said he appreciates being knowledgeable, not awed, about new technology when interviewing for a job. "It's a good selling point for me because I can ask intelligent questions about the topic," he said. "Some places where I've interviewed have told me they'd like their next partner to be EHR-savvy."

Chief resident Ann Rodden, D.O., said when she interviews, she asks whether the practice has implemented an EHR system. "If the physicians don't have an EHR system, they at least have to be open to getting one, or I cross them off my list," she said.

Third-year resident Priscilla Holtzclaw, M.D., was surprised to hear that Trident is in the minority when it comes to family medicine programs offering on-the-job EHR training. "Really?" she said. "I don't know how we'd pass patient information between us if we didn't have an EHR."

Access. Access. Access. All of the residents can access a patient's record electronically whether they're in the clinic, at the hospital across the parking lot or at home. Chief resident Amy Black, M.D., appreciates home access. "When I'm taking a phone call at home from a patient, I can pull up that record instantly, so I don't have to go over the person's entire life history to answer, Can I take this product safely with the medications I'm on?'" she said.

With electronic patient notes, the agony of attempting to decipher colleagues' scribbles is a distant memory. "Everybody can read everybody else's notes. We've eliminated errors caused by bad handwriting," said Black. And the use of templates imbedded into the EHR makes information easy to find because the template is the same for everyone. "I'm not hunting for information," said Black.

No one here misses "missing" charts. "Other places I've ever been, folks spent a lot of time looking for charts," said Rodden.

William Hueston, M.D., family medicine department chair at the Medical University of South Carolina, Charleston, shared what he tells colleagues when they admit letting their fear of computer crashes curb their EHR appetites: "Yes, computers go down occasionally, and when they're down, we're 100 percent down. But all other days we have 100 percent of our charts."

Hueston also applauds computerized records for reducing the mental strain physicians face. "The culture of medical education is that we rely on memory," said Hueston. "We make errors because we don't look things up -- and we don't look things up because it's a sign of weakness." EHRs get physicians away from memorizing and move them "to the wisdom of knowing what we need to know," said Hueston.

There are enough computers for the program's 34 residents to be online simultaneously, so there's no excuse for not taking advantage of online medical databases.

Hueston is pragmatic about the shift from paper to an EHR system. "It's a tool," he said. "It doesn't change medicine. It makes the practice of medicine easier."