After months of training, anticipation and even dread, my practice began transitioning from paper charts to electronic health records (EHRs) this week. It was not pretty. Frustration hung heavy in the air amidst whispered curses and even some tears.
To accommodate the transition, provider schedules were lightened. But even with fewer patients to see, we were all running behind. Many patients were angry about their long wait times, despite the signs that explained the transition that were posted on every available surface around the waiting room.
I found myself floundering to find a new routine during each patient encounter. I tried listening to patients and focusing on what they were telling me, but often I found myself staring at the computer screen trying to figure out where to document what they were telling me.
One of my colleagues is coping with the transition by writing everything down on paper during the visit, and then charting the case in the computer after the visit – at least, until she figures out where everything is. This may be easier, but it is certainly time consuming, and in some ways, defeats the purpose of computer charting.
Despite attending training for the new system, I felt lost when trying to put everything together. I did not experience any problems entering a patient’s history, documenting my findings or prescribing medications, but at the end of the first day I realized I had not entered a single diagnosis or treatment plan for any of the patients I’d seen. This will surely be problematic when the chart is reviewed for billing purposes.
I know that getting everything to flow naturally and feeling like I’m giving my patients more attention than the computer screen will take time. Another part of the problem is that our EHR system is not designed for Ob/GYN use. For example, I do STD testing on at least 50% of my patients, but there is no obvious place to document these labs. This will require necessary adjustments and additions to the system.
I’m currently dreading the moment when our patient volume will return to normal. I doubt that the time allotted for EHR transition is enough for any of the providers to really improve their data entry time. I fear that this will translate into longer wait times and increasing patient dissatisfaction.
Eventually all paper charts will be removed from the building, so everything important must be flagged to scan into the system before the chart disappears. I worry that we will miss scanning something crucial that will affect patient care.
I also feel that there are many ways in which EHRs have already made my job easier and more efficient. I love the ease of e-prescribing, and having remote access to charts and prenatal records while on-call on weekends or holidays. This wwill make phone triage a lot simpler. EHR use also eliminates much redundancy and double charting.
EHR use will eventually become routine practice, and I’ll appreciate its convenience and benefits. In the meantime, getting there is the hard part.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.