Case Studies
Solo GP Embraces Technology to Ease Complexity of Care
Dr Lianne Lacroix is a solo GP in Kelowna who has been in practice for 38 years. She describes herself and her MOA as "not computer advanced people at all," but despite this they implemented an EMR in 2008.
Advice to Colleagues
"Go for it! The sooner we are all EMR the sooner all these pieces of paper will stop coming at us – the greater the benefits for us all."
"Take enough time (a day or half day off from seeing patients for several months) to devote to setting up your system and learning it, unless you are computer advanced already."
"Really research everything on the internet, such as reading all the PITO info. For the hardware, go slow, research and find what will work for you. I have a small printer that fits in the cupboard in each of my exam rooms, as I like to give patients their labs and reports etc, and I hate to run out to print them. It took a while to find them but they are invaluable."
Unknown Territory
She admits it was a scary prospect: "My greatest concern was venturing into unknown territory - were computers advanced enough to be reliable? Are they simple enough for two non-computer advanced people? Will I keyboard fast enough? Do I have to scan all previous patients' files?
"To advance medicine we must overcome our fears and press forward. The files are so BIG by now and things are getting more complicated… more tests, more specialists, more medications. We are running out of physical room."
"We cannot grasp the complexity of our chronic complicated patients by piles of pieces of paper. We need the EMR to help us - there is no other option."
Taking Time to Overcome Challenges
Once she'd overcome her fears and made the decision to implement EMR, she says: "The greatest challenge was to set aside time. I took every Wednesday as EMR time; we'd see no patients but only do paper-computer work. The vendor was very good but we had our share of technical problems – it almost drove us nuts, but we persevered and they were solved in the end. Only by working with the system can we advance to make it better."
As for her other concerns: "I did get faster at typing. Another option would be voice recognition software, which is used by our local gynecologists very successfully. Scanning is not easy. We have NOT scanned all the files going backwards, and I have trouble physically letting go of them, especially when the patients say 'when was my last physical, Pap or colonoscopy'. There is still some paper coming to us that we scan."
Easing Burdens
The greatest benefit is less filing: "Lab tests, X-ray reports and all the hospital info come automatically into the patient file very fast. We no longer have to file all these paper reports or search for them in the BIG patient files. I also very much appreciate the professional referral letters that I write to specialists with the automatic past history and list of meds. This was a real burden before—not anymore!"
Another advantage is finding patients and their details quickly: "Someone called Mabel calls but doesn't give her last name before she hangs up. In the EMR we can request all 'Mabels' and identify her right away. When patients phone for lab results my MOA just brings them up on the EMR, instead of running to their big file and hunting inside."
"There are many small things that all add up... and computers are FUN!"
Future EMR benefits include addressing chronic disease management, and "...sending and receiving letters back and forth to specialists online through the EMR – no more faxing, mailing and scanning! I hope this comes soon."
Support from PITO
PITO helped Dr Lacroix through implementation by being "...a source of encouragement; and their process helped us to consider the bigger picture and the privacy issue for patients. With them I met my physician peer mentor - that helped –he listened to my story with sympathy."
The Future is Now
"I have been waiting for a long time for this day to come. I only wish I still had more time in front of me than behind."
Dr Lacroix firmly believes that EMR and eHealth are the way of the future: "Years from now my practice will have a new, fast-typing young doctor with no paper files around at all – except a few in the basement. She will have a small tablet computer as she goes into the exam rooms, easier to navigate, full of the latest info. She can take it with her on nursing home or house calls and dictate notes as she goes with built-in voice recognition. She'll be connected to Pharmanet so she can see what the cardiologist just ordered and so on... When I was in med school some 40 years ago they showed us an early computer and said that someday this tool will help you with patient care."