A Short List of Technologies Changing My Practice

Was asked for a short list of what technologies have made a difference in my practice over the last year and I rapidly jotted down the following:

Large screen devices

• Our clinic started with small notebook computers primarily designed for the physician and nurses to carry from room to room.  Severaly years ago it became apparent that we often needed to share what was on those screens with patients (primarily diagnostic imaging and lab results).  The hand-held devices didn’t cut it.
• We moved to 19″ regular monitors and after some experimentation ditched the notebooks and took the minimal added time to log into inexpensive autologon desktops and increased the size of the monitors to 21″ swivel devices
• Now have gone to 24″ HP All-In-One touchscreen devices for nurses and patient rooms because we discovered productivity is proportional to screen real estate and the added dimensions of the touch screen enabled us to include patient input into the documentation process in the exam room

Photos and videos

• Having a current patient photo on every page view of the chart (usually in banner bar) reduces errors of performing actions on the wrong patient, reduces the need to dig for information (pictures jar our memories in ways names cannot)
• Having pictures of rashes, wounds, deformities provides more information for downstream readers than any amount of words
• Including videos of tremors, gaits, movements improves diagnoses
• Provides excellent teaching tool
• Has dramatically decreased the amount of descriptive text and time to completion of notes without sacrificing information
• Enables visit-to-visit comparison that is just not possible with text

Electronic Messaging, especially with patients

• Asynchronous messaging reduces interruptions for both the clinician and the patient and is more efficient than voice.  Patient’s complaints are in their own words eliminating the need for redundant recording of the interaction
• Improves communication without adding cost and dramatically reduces time spent on the phone. Secure messaging enables electronic transfer of patient information to outside physicians in need of that information when normal record transfer mechanisms are not available

ePrescribe

• Especially the External History has the potential to change the conversation (discovers those who have not filled prescriptions as well as those that are doctor shopping)
• Also having access to the medications covered by specific plans and the co-pay for those medications is what I call REAL DECISION SUPPORT … now if only we could get the same push for covered services

Point of Care use

• Improves timeliness and also accuracy of the interaction
• Increases the perception of time spent with the patient
• Increases confidence and satisfaction

Patient Access to chart, especially visit notes

• Improves the accuracy, integrity and timeliness of the notes
• Try to review and write the note (even though I’m using 100% template driven documentation in the clinic) with the patient as the next reader and editor of the note.  Takes a little more time but forces me to be judicious and accurate in my documentation which I’m convinced improves patient care

Interfaces and connections … Health Information Exchanges

• The power of an EHR increases logarithmically with the number of systems to which it is connected
• HIE connections have the potential to increase productivity (see new patients in the same time as established patients)  and why they are not catching on is beyond my comprehension as they enable a clinic to schedule and see new patients in the same time slots as established patients by dramatically reducing the amount of de novo data entry required to make medical decisions

There are many more technologies and infrastructure changes that are positively impacting health care but these are the ones that came to mind as fast as I could type them.

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