How Can We Cope With the Stresses the EMR Causes?
By Tom Benzoni, MD, FACEP and Rita A. Manfredi, MD, FACEP
Solutions - Start with the Patient
- Etiquette. Sit down in the patient’s room. There's a reason the computer is called a laptop. Face the patient over the top of the screen so that you can see the patient’s face and eyes.
- Learn keystroke shortcuts to allow you look at the patient while your fingers get that old document or lab. Don't know your software shortcuts? This may be the time to meet with your super-user in the department. Look at www.makeuseof.com/tag/windows-8-keyboard-shortcuts/.
- Have a document page open. Take your own shorthand notes on the computer while you talk to the patient. You can acknowledge the computer's presence, patients will understand.
Adapt to the technology - it’s not going away
Exploit some of the other tech tools available to put the EMR back in its cage.
- Pick up the Dictaphone, use Dragon dictation software, save a simple .wav sound file to the record (it comes bundled with any modern OS), or use Google Speak. Dictate a short summary note. Skip the pre-set templates and just talk or type:
Why the patient came to the emergency department.
What you found.
What you did.
What you want the patient to do.
- Hire a scribe. There is a huge literature base on this topic, clearly showing a scribe will pay for him/herself. Hospital won’t do it for you? Then hire one yourself. You CAN afford it and you CAN’T afford to let this stuff drive you crazy!
- How do you handle the software that you must use during the visit? Go mobile. If the hospital won't buy a tablet, get one yourself. You may need to remote in from within your own facility, but it's worth it.
- Make a Favorites file that is useful and arranged the way you think. (Therapeutic Drug class? Chief complaint? Odd or critical workups? Special tests that are buried in the mass of entries?) Store what you need to remember for treatment of hyperkalemia in one place. Chest pain is just begging for its own directory.
- Use Macros/shortcuts/pre-configured order sets. These repetitive functions are the real strength of using a computer. Invest the time to set up your own Macros. Copy or share ones developed by your colleagues. Your Information Technology staff or department super-user is there to assist you and it will only cost you a sincere “Thanks!”
- Keep your common tests in the root directory of the favorites file - CBC, basic electrolytes, urinalysis, etc. (Optimally, a modern EMR would push your most common tests to the top, but that's a future topic.)
- Use a laptop or a Computer on Wheels (COW) and load the PACS onto it to bring the radiology study to the bedside. Patients love to see the images, and it's a major time saver for you.
- Learn how to access a graph of lab results. A line showing the downward trend in the hemoglobin for a GI bleed is much faster than trying to explain numbers.
- Show off your knowledge of past events by having prior visit dates and diagnoses pulled up on your screen.
What if you still are frustrated with computers? Be optimistic. The software someday will catch up to your expectations. Or you can design your own program. Be sure to share your EMR coping strategies with others, especially the new doc joining the department.
EMRs are here to stay and we are the ones who will need to transform them so they benefit both the clinician and the patient.