Case Studies
Rheumatologist's EMR Makes Practice Safer, Cheaper, More Efficient
Dr Kam Shojania is a rheumatologist based in downtown Vancouver who's been in practice for 16 years. He says he chose rheumatology as a specialty because of encountering "interesting patients with unusual conditions".
Advice to Colleagues
"Just do it. It doesn't matter what stage of your career you are at."
"It will save you money. Unless they're storing paper charts, rheumatologists don't need a lot of space, and office space is expensive. Plus there's the cost of storage and shredding."
"Use a fax server and e-signature pad so you can write prescriptions on the computer and send them electronically; and get a speakerphone so you can talk and type."
In 2008 when he moved his office to downtown Vancouver he decided it was the right time to implement an EMR. "I realized it was more economical to scan and shred my charts compared to boxing and moving them. We scanned three years' records and stored the rest off-site. We were able to save space and money in the long run," he said.
No Longer a Chore
Because rheumatologists care for very sick people with complex chronic diseases, it's particularly important to maintain good communications with other doctors and to monitor lab results very closely and in a timely manner. This used to be a chore:
"Before I implemented the EMR, I'd have a big stack of lab reports sitting on my desk. I'd go through it circling any abnormal results and give my MOA a list of charts to pull, then get the charts back the next day and match the lab results to the patients. Now I have an electronic inbox. One click shows me the patient, their disease and their medications."
"I can do my dictation, billing and labs and go home at a reasonable time. It simplifies my life."
When Dr Shojania was away for a few days, at conferences or on vacation, that big stack of paperwork used to really pile up. Now he can deal with it anywhere and anytime. Not everyone likes the idea of working from home, but: "It needs to be done anyway, and it's better than staying late at the office." The efficiency of using EMR means he can go home on time.
Working More Efficiently Increases Productivity
Appointments are the same length as before but he can accomplish more patient-related work: "The patient doesn't have to sit and watch me filling out requisitions. Forms and letters get done automatically, and I can even give the patient copies of them to take home because it all gets done during the visit instead of being extra work afterwards. I see more patients now. I work 20 to 30 per cent faster."
Patients love the fact that they can get lab results within hours: "They'll come to the office and apologize because they only remembered to do the test that morning; and they're amazed that I already have the results."
Better Communication and Patient Safety
Communication is easier too: "I can speak to a GP on speakerphone, call the patient's record up immediately and have all the relevant information on screen while I talk. And when I get electronic memos from my MOA (instead of sticky notes), I can fire them back right away, stamped with the date and time, and all recorded in the system – it's safer, and it's a legal record."
Patient safety is hugely important, and because Dr Shojania no longer relies on memory and can easily check patient records, he says EMR has made his practice safer.
MOA Loves the EMR
MOA Cyndi Rosenbaum was initially unsure about EMR. "I hated the idea at first – I was scared. Now I love it. I got up to speed much quicker than I expected. Scanning and transferring paper records was painful, but we were moving anyway, which is stressful too. It was definitely worth it," she said.
Now Dr Shojania is looking for additional EMR benefits such as e-prescriptions, and "...a patient 'portal' so the patient can see labs, book appointments and get reminders automatically".