I had a patient today ask me if I still had the notes I made from when I first saw him Sure enough, I was able to read from my notes from 1991 - and he was impressed. Over the years I have been migrating my patient notes from each EMR I've written until they are now all in Synapse [H]
Add some tags and metadata searching and all that goodness is at your fingertips ! Having that much data provides interesting opportunities and challenges. Q: is the EMR that looks good in the first 3 years of use, the EMR that looks good after 20 ! I suspect NOT !
Jason, what are you thinking of in an EMR that would not look good in 20 years if it was well designed? Dr. Lawrence Weed and his SOAP notes have remained a pretty much permanent fixture as long as I have been in US medicine. Sure, more stuff gets added, like occ med stuff and so forth to the SOAP notes, but they haven't really changed much. Graphs and pictures have always been there. I believe you mean the simplicity/complexity/user friendliness of the interface that produces the notes. Checkbox templates have become more popular here in the US for urgent care/ER stuff. For longevity, I can't say I like them. I believe regular old consult notes are easier to read, and are certainly "durable". Were you thinking of registries, chronic care and all that stuff? I'm really not sure just how long-term usable or durable all that stuff is.
How does your EMR function with 20 years of results ? Can you find the patient's bone density that is 11 years old ? Easily ? Can you new nurse determine if the patient has ever seen a Cardiologist ? Can your locum find the patient's stress echo from 8 years ago ? The patient is having a headache, can you find the notes dealing with Headache from last month and 9 years ago ? Does having 20 years of data slow your EMR down ? or 2 years in the case of Amazing Chart 3.0.x ? When was Atenolol started on this patient ? When was the Atenolol dosage changed ? Is the word dysplastic (as in nevus) in the patient's chart ? With 20 years of data: can you see the trees and the forest ? Does the information about the patient get better with time (cumulative results) or just more entries ? Is the patient's "Diagnoses" cluttered with Sinusitis and you can't find the info about Hypertrophic Cardiomyopathy ? etc. [] FWIW, Synapse does quite well on alot of fronts that MANY EMRs fail miserably on. [Y]
How does your EMR function with 20 years of results ? My remr.fdb is only about 76 megs right now, and not sure about exactly how many Rx pdf's in cache-listener, but I think about 300, and still pretty snappy. How fast is synapse working for you right now? How many total patients? Real paper charts at my urgent care center basically suck, and are much more time-consuming and expensive to maintain that any decent EMR. Can you find the patient's bone density that is 11 years old ? Easily ? Not sure on that one, but if you file labs/imaging in synapse systematically, is it hard? Can your new nurse determine if the patient has ever seen a Cardiologist ? Like a paper chart, wouldn't that be related to how you file incoming notes, labs, imaging and consults? Maybe make a brief synapse consult with appropriate tag just to record a quick synposis of the consultant's findings and recommendations (drag and paste if the consult note was OCR'd). Print all consults to a browser like Graham discussed as report to see everything "end-to-end" if you need. The patient is having a headache, can you find the notes dealing with Headache from last month and 9 years ago ? Not sure about synapse's abilty to search for strings in a consult note other than to use the custom query function. Maybe that's something that needs to be discussed more?
[quote user="jparkdo"] Not sure about synapse's abilty to search for strings in a consult note other than to use the custom query function. Maybe that's something that needs to be discussed more? [/quote] Tags work on the consult note ... so you could create a "headache" tag, and so bring up each consult that headache was discussed.
I just tried using the "Print All" filter in classical view to print all consult notes to FF, then just use the "Find" function to look for any search term. That's quite fast.
Since the "Print All" filter includes pharmacy, if you've included all Rx's in a consult note of some sort, you can use the browser's "Find" function to find all instances of Atenolol.
[quote user="jparkdo"] How fast is synapse working for you right now? How many total patients? [/quote] Synapse is blazing fast []. I have 1,700 active patients and about 2,000 entries. Synapse <strike>fairs</strike> fares quite well on my demanding list of "Will synapse work well in 20 years". Most EMRs do not.
