Case Studies
How to Minimize Typing and Maximize Macros for Effective Complex Care
Dr John Griffioen is a GP in an eight-physician practice in Creston. He has been in practice since 1994, and in Creston for 13 years. Before medical school, he studied to become an electrical engineer in Ontario; but he loves rural medicine and thinks Creston is a great place for his family. The practice implemented an EMR in December 2009, and is part of the Kootenay Boundary and Creston Community of Practice (see www.kbc-cop.com).
Advice to Colleagues
"Take your time. You start thinking of ideas along the way. You have to play to your strengths, do things your way. Do it in little chunks, get comfortable with it – it's more achievable that way."
"Involving MOAs and staff is essential for it to work, especially in a large office. The transition to EMR was huge. We're very lucky with the staff we have – they're motivated, positive and supportive, and our office manager is great. It wouldn't work otherwise."
Dr Griffioen is sometimes known as 'the doctor who doesn't have to type', but that's not quite accurate. He does type;but he tries to minimize it. He said: "I didn't want to be always looking up from the keyboard."
"I was nervous about implementing EMR. As much as possible, I wanted to emulate the way I worked before. I didn't want to be leaving the office later. Actually, I'm leaving earlier."
How Has He Achieved EMR Success?
"There are two exam rooms and a central office, with a semi-private corridor. Each exam room has a computer – but the keyboard and mouse are hidden under the desk and used as little as possible. There is a Bamboo tablet on the desk top that uses handwriting recognition software. The tablet's screen is divided to include Profile, notepad, and an area for the Dictation Box used within Dragon Speak. The exam room PCs connect via Remote Desktop to the central computer, which is the only one running the EMR.
"I use the notepad to make notes for myself and to write shorthand 'codes' to bring up templates and macros. For example, I will write IN with a circle around it to bring up a patient instruction template, which I can fill in to tell a patient how to take a certain medication, for example. That patient instruction is available for me to cut and paste later into the patient's record, so I have a permanent copy. I will sometimes type notes at that point as filler for the instant handout I gave the patient."
Macros and Automation
Dr Griffioen's handwritten shorthand can initiate macros in the EMR software. For example, VS with a circle around it brings up the current vital signs template. Other macros include patient health questionnaires (PHQs) for depression, sinus congestion, musculo-skeletal problems, etc. He also finds it useful that "...I can enter values in imperial measures, and the EMR will convert it to metric – it's very handy."
EMR Easily Facilitates Complex Care Action Plans
"The EMR is most powerful when used for complex care patients (for example patients with more than one chronic disease) who need an action plan," said Dr. Griffioen.
"For example, I can open a macro and create a generic action plan, then fill it in using other templates for specific diseases. I can easily record all the current data and instructions in one place: status, labs, goals, what to do if things go wrong, how to get the disease under control. I can see the relevant patient history – shots, vital signs, BMI. I can see the patient's current meds and problems, all on the action plan. I can record end-of-life wishes. I can be sure that I've met Ministry of Health requirements. And it's all done in the room with the patient."