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EMRS For Dermatology Care
Ease In With Careful Planning and Selection
How many ways can you describe a blister? You've no doubt seen them all. Today when Fred Blum, a dermatologist in Durham, N.C., treats a patient with a blister, or a rash for that matter, he no longer has to run through his mental thesaurus and pen his personal observation in a paper chart.
Instead, Blum and his partner at Triangle Dermatology Associates, PA, simply click off the most apt adjectives provided by their MediNotes Corporation electronic medical record (EMR) and move without delay to the other significant aspects of the patient's visit--such as coming up with a diagnosis and treatment plan. "I spend much less time doing the more mundane stuff and more time charting with the more important things," says Blum, who has had the EMR for two years.
Kentucky dermatologist Artis Truett is also reaping the benefits of his EMR, made by NextGen Healthcare Information Systems, Inc., which he has had for five years. "We are doing a much better job of answering [patient] questions and responding to their needs," says Truett. "I think the level of patient care has increased dramatically," as has the "customer service" aspect of his practice, Owensboro Dermatology Associates, PSC. Truett wishes more dermatologists would come into the EMR fold. "I really want other dermatologists to adopt EMRs. I would like to have a dialogue with other practices that have done EMRs. I think we are really at the beginning of the whole process, and there is a lot that can be shared, and a lot to learn. I am always willing to change, and my partner is, too. We are not stuck in the past.
First, Understand Your Needs
Truett and Blum are true believers in EMRs. But they weren't always that way. Like other dermatologists, they feared spending too much on the wrong product, ending up with a system that didn't interface with their other software, and getting stuck on hold while frantically calling their vendor's help line. They also worried about having an EMR that didn't reflect their needs as dermatologists. Then there are the patient-related fears, often centered on slowed documentation and increased wait times. None of their fears came true, thanks to a careful process of vendor selection, phased-in implementation, and their active involvement in troubleshooting the system once it was installed. These are key to a successful implementation and to combat the fear associated with EMRs, says Robert M. Tennant, senior policy advisor for health informatics for the Medical Group Management Association (MGMA).
Before dermatologists make any decisions, they should begin the process with a thorough understanding of their own needs, Tennant says. He advises having a checklist of things your system should be able to do. "The question to ask yourself, as a dermatologist or a dermatology practice administrator, is, 'How do I want my EMR to impact and improve my practice?" says Tennant. "Is it simply better recordkeeping,...e-prescribing, treatment protocols. ...When the physicians want to move away from a paper health record, it certainly broadens the opportunity for system changes. However, the more functionality you want, the more demands you have, the fewer product choices you are going to have. It's unlikely that any system is going to meet all your needs."
Don't go blindly into an EMR purchase and installation thinking it won't cause changes. Once you understand how the EMR functions, "Ask yourself, 'How will this impact our workflow, and the way that we practice medicine?'" Tennant suggests. Consider also whether the timing is right, and weigh your decision against other technology and patient needs of the practice. Tennant notes that dermatology practices tend to be smaller, so they may need to decide whether to build on existing practice management system (PMS) software or convert everything at once. "To ensure a seamless transition, it might make more sense to convert to a fully compatible PMS and EMR at the same time," Tennant says. "In many cases," he warns, information technology (IT) "systems have failed because of poor integration between administrative and clinical systems."
Custom Tailored?
Like other specialists, dermatologists must address the issue of whether to purchase an EMR designed for their field, or choose a basic one and tailor it themselves, relying at least partly on the embedded features provided by the vendor. It isn't necessary to get an EMR made just for dermatologists, Tennant says, "as long as you can customize it to meet your needs." Blum says he never considered a dermatology-specific EMR. "[Dermatologists] do have needs, but they are similar to other specialists," he says.
Among the issues to be factored in is the "viablility of the company," Truett says. "I wanted to go with a company that was financially secure. If [a firm] came out with a just-dermatology product, but they were a small company, you'd have to be careful."But both physicians knew certain EMR features would be important to them as dermatologists. "I wanted a program that had a lot of graphics capabilities," Blum says. His EMR enables him to pinpoint the location on the patient's body of any problems. "You can put a mark right where the lesion is," he says.
Recoginze, too, that these features may not be standard. Adds Tennant, "In many cases, physicians will have digital cameras, and you want to be able to store high-resolution images. If a practice goes in that direction...don't skimp on disk space." Storage capability is crucial for optimized use of digital imaging: "Whatever size hard drive you think you need, "says Tennant, "double it." There's no quicker way to annoy dermatologists and other users of the system--and impede patient care--than by subjecting them to a slow system. And a hard drive that is running out of space slows data retrieval considerably.
An EMR that is not designed specifically for dermatology will need some tinkering, which makes having a responsive vendor all the more important. For example, MediNotes included graphics for all parts of the face, but not the top of the head. "Bald guys have all kinds of trouble on the top of the head, "Blum says. He was able to work with MediNotes to add this feature. Such a relationship is important. Good EMRs are always evolving, and those vendors that value the input of practicing physicians--and act on their suggestions--are able to best accommodate the real-world practice environment.
Learn From Others
There's no substitute for seeing the EMR in action. Ask potential vendors for references, and make site visits yourself if possible. The fact that NextGen didn't have a lot of dermatology clients wasn't an issue for Truett. "I visited one of the practices in Texas. I went out with several members of their staff," he says. Not only was the visit valuable, but he still stays in touch with the practice, getting advice and support when needed.
To make the most appropriate comparisons, Tennant advises visting practices that share your specialty, size, and general patient demographics. This will also give you an idea of other features you might want, such as remote access. Both Blum and Truett are able to access their EMRs from their home computers, which is invaluable when the physician is on call and is summoned to care for a another dermatologist's patient. "Some patients know that dermatologists will give codeine if you call on the weekend," Blum says. Without access to a patient's chart, it might be unclear when such a request is a ruse. "That hasn't happened since we got the EMR," Blum says. "But there have been dozens of times when I wasn't sure what was going on, and I could go to the note and [help the patient] from home, and I can do a quick note on what I did."
One way to minimize problems integrating an EMR into the practice, Tennant says, is to "create a super user--a nurse or an administrative staff member who can be an expert on the system, who can be around so you can say, 'come on down to my office,' when you have a problem. You can't assume the vendor will hold your hand." Truett's last piece of advice: "Be prepared to take on a challenge." EMR implementation, he says, "is not for the faint of heart. [But] the end result has definitely been worth it."
By Theresa Defino
The Patient-Centered Dermatology Practice
