EHR Improves Work Flow, Patient Care

Seeing is believing. If you're still waffling about whether an electronic health record system can work for your practice, go see a successful one in action. Spend a few hours with an FP reaping the rewards of a paperless office. You'll likely come away a believer.

Take, for example, FP Susan Andrews, M.D., who was turned on to an electronic health record system in October 2000. Since then, Andrews and her three partners (including her husband, FP Randall Rickard, M.D.) have successfully used the EHR system to deliver medical care in Murfreesboro, Tenn., a town of 80,000 residents.

FP Report visited Andrews' practice and found it running seamlessly. This story -- the second in a series on the new model of care proposed in the Future of Family Medicine report -- shows how an EHR system can revolutionize patient care.

It's just after lunch on a hot July day, and Andrews prepares to see her first afternoon patient. Sitting at her desk, she glances at her computer and learns a nurse has entered the patient's vital signs and clicked on the purpose of the visit, "physical." Andrews chooses a template (she's set them up by patient age) and pulls up the patient's medical record.

Now Andrews has right in front of her all the recommended screening tests for this particular patient. Is she past due for a tetanus shot? Red flag. Is it time for a mammogram or cholesterol screening? If so, another red flag. This quick and thorough overview of the patient's chart is done before Andrews ever enters the exam room.

She scoops up her laptop and swings down the hall to check on her patient. "It's just second nature," she says of the computer held in the crook of her arm.

When she enters the exam room, the patient isn't surprised to see Andrews toting a computer. In fact, patient Gloria Daniel appreciates the health care she receives from Andrews, care Daniel says is enhanced by an EHR system.

"It's an excellent way to keep accurate records," says Daniel, who has a long history with Andrews. "There's no question from one time to the next about what's in my medical record because she has everything right in front of her."

Translation: Forget the bulging paper chart with randomly inserted telephone notes and test results.

In the exam room, Andrews types patient notes right into Daniel's chart. The conversation is fluid and intimate with good eye contact. "I get most of my notes done in the room with the patient," says Andrews.

Translation: Gone is the stack of charts waiting for completion at 5 p.m.

Andrews' computer screen displays a list of Daniel's current medications. Andrews asks about each and every one: "Do you still need this? Are you still taking that?" Refills are a snap. So are medication changes.

"I can write prescriptions quickly with a few clicks, and the prescription goes into the note automatically," said Andrews. After the visit, the prescriptions are waiting at the printer for Andrews to sign.

That's not all of the exam room magic. Andrews' office is wireless, meaning she has Internet access without being tied to a cord in the wall. So, when a patient shared plans about an upcoming trip to China recently, Andrews instantly went to the CDC Web site to gather vaccination information.

Patient education sites are readily available; handouts, just a keystroke away, can be picked up along with those prescriptions waiting at the printer. Ditto for form letters patients need, such as a physician note excusing a work absence. Fill in the blanks on the form letter template and hit print.

Translation: Every task completed before the patient leaves the office is one less task to do later.

Each of the four physicians in the practice can tweak the system's templates to fit their styles. And while Andrews prefers to complete patient notes in the exam room, her husband's work style is different. "I'm a procrastinating documenter," says Rickard, found sitting in the medical office's tiny kitchen entering the morning's patient notes into his computer.

Rickard stops his work to show off the system's graphing element. "I use the graphing fairly liberally to show trends and connect information for patients," he says. In fact, he had used graphing that morning to illustrate a patient's weight and cholesterol trends.

With the patient by his side, Rickard positioned two graphs side-by-side on his computer screen and asked, "Do you see a correlation between the rise in your weight and the rise in your total cholesterol?"

The overweight male -- who had repeatedly turned a deaf ear to Rickard's requests for him to lose weight -- had an "aha" moment. "Oh, yeah. I need to come back on my weight," he said. Point made, patient education battle won.

Translation: Rickard may see a healthier patient in the future.

"The EHR system has improved care," says Rickard.

"It's made me more passionate about being a family physician," says Andrews. "It's added a little excitement after doing the same thing for 19 years. I feel like I have the tools to do a better job."