We’ve all done paper charts.  Most of us have done literally tens of thousands of them.  They’re comfortable for us like a pair of old sneakers is comfortable.  We’ve used so many of them we know exactly where to look for information, we have certain things we write, and our work habits are well established.

Making the change to EMR requires a little adjustment.  Here are some tips to make the transition easier:

1.  Charge right in.  You won’t be able to review the chart before you walk in the room.  This is unnerving at first.  With a paper chart you can see why the patient’s there, review the patient’s interval history, and look at the data the technician has gathered prior to entering the lane.  Unless you are using a tablet or iPad (I don’t), or you look at a computer in the hallway (which wastes time), you won’t be able to review the chart data before you go in.  I’ve found this to be less of a problem than I thought it would be.  I go right into the room, greet the patient, and ask how they are doing.  I then review their note on the computer and go from there.

On our system, we print a summary of the patient’s continuing history (PMSHx, SHx, meds, FHx, allergies) which the patient updates in the waiting room if they have time.  This sits in the old chart bin outside the room, so at least when I go in I know their name and some history.  If your system supports this, it can help.  If not, and you’re still uncomfortable with going into the room cold turkey, you could have a technician leave a small note in the bin with the patient’s name and a short sentence about why they are here.

2.  Avoid talking to the patient while you are looking at the screen.  When I walk in the room, I greet the patient in a general way, and then say “Let me pull up your chart.”  I then log in, briefly review the technician notes, and turn to the patient to discuss how they are doing.  I avoid talking to them while I’m looking at the display (those of you who have kids will know how annoying this is).  I then complete the exam, discuss my findings and plan with the patient, and say “now let me make a few notes” and complete my EMR note.  You’ll find your own strategy, but this works well for me.

3.  Involve the patient.  We have large 22” LCD displays in our rooms that everyone can see.  The patient can see what I see and can see what I’m typing.  I chose to do this for maximum transparency and patient involvement.  This  took a little getting used to because with the paper chart I was used to some confidentiality, first because it wasn’t displayed, and secondly because it’s hard to read my writing.  Now that the patient can see everything, I love it.  I find that they are much more involved in their care.  They are more easily able to see and correct their medication list, I can show them images and drawings, and they see the complexity of what we do.  They have confidence in what we’re doing and see that we’re not hiding anything.  They also love the high-tech look of it.

4.  Don’t buy a slow system.  Make sure the system you buy is able to keep up with you.  There’s nothing worse than having a patient about to get up and leave because you’re taking so long on the computer.  The system you get needs to be at least as fast as the paper chart or you and the patient will be frustrated by the delays.  Avoid systems with lots of clicking, multiple windows, slow response times, and overreliance on checkboxes.  Web-based systems tend to be slower than local server-based ones, but if you do get a web-based EMR make sure you have a fast and reliable internet connection.

5.  Maintain your equipment.  Make sure your technicians know the startup and shutdown procedures for your computers and your EMR.  You should never walk into a room and have to turn on the computer, open the EMR, or search in the EMR to find your patient.  When you walk in you should be able to log in and have the patient right there on the screen with the appropriate data displayed.  Similarly, your technicians should make sure that there is paper in the printer so you don’t run out in the middle of an exam.  Posting standard procedures for startup, shutdown, and maintenance can eliminate frustrating delays when the patient is there.

6.  Know your system.  You’ve just bought your EMR, now it’s time to learn it.  Just like in residency when you had to figure out a new paper exam template at a new clinic you went to, you have to figure out the layout of your EMR.  Some are easier than others, but whatever you bought you need to learn.  You can be the best ophthalmologist around, but if you sit there at the screen trying to figure it out with the patient in the room you won’t look like it.  Kids figure out computers much faster than adults because they’re not afraid to get on them and try things.  Play with your new system for an hour or so, entering some test patient data.  It’ll pay off in spades when you are in your clinic.  Barring that, have a competent tech or vendor rep be with you for your first few patients.  Purchasing an EMR that’s easy to use helps too, of course.

The best way to figure out your routines when starting out is to start slowly and give it a little while.  Get a good EMR and learn it well.  Soon it’ll be part of your routine and you won’t look back.