Norway - Effects of the use of an EMR in Primary Care

Certain countries have had a lengthier experience with EMRs than others. Norwegian GPs began to adopt EMRs in the early 1980’s. Over 95% of Norwegian GPs have been using an EMR for the past 10 years. A study of GPs use of EMRs conducted in Norway and reported in BMC Medical Informatics and Decision Making seeks to understand the actual benefits and effects of the use of EMRs in a system in which a high uptake of EMRs tends to be looked upon as a proof of their value.

Abstract - Background:

In spite of successful adoption of electronic patient records (EPR) by Norwegian GPs, what constitutes the actual benefits and effects of the use of EPRs in the perspective of the GPs and patients has not been fully characterized. We wanted to study primary care physicians' use of EPR systems in terms of use of different EPR functions and the time spent on using the records, as well as the potential effects of EPR systems on the clinician-patient relationship.

Methods:

A combined qualitative and quantitative study that use data collected from focus groups, observations of primary care encounters and a questionnaire survey of a random sample of general practitioners to describe their use of EPR in primary care.

Results:

The overall availability of individual patient records had improved, but the availability of the information within each EPR was not satisfactory. GPs' use of EPRs were efficient and comprehensive, but have resulted in transfer of administrative work from secretaries to physicians. We found no indications of disturbance of the clinician-patient relationship by use of computers in this study.

Conclusions:

Although GPs are generally satisfied with their EPRs systems, there are still unmet needs and functionality to be covered. It is urgent to find methods that can make a better representation of information in large patient records as well as prevent that use of EPR systems contribute to increased administrative workload for physicians.

Link: BioMed Central | Abstract | 1472-6947-8-12 | Instant availability of patient records, but diminished availability of information: a multi-method study of GPs use of electronic patient records.

My sense is that in order to achieve efficiencies with technology and EMRs, one needs to examine the process of care delivery at a very granular level. Once the adoption phase is over, using the EMR effectively depends on defining a specific outcome that one wants to achieve and then re-engineering the process.

Have you had experience with this process? Do you agree with the findings in this study? Does the EMR in your practice provide definite efficiencies? If so, how did you achieve those efficiencies?

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Comments

[Margaret Tromp]

I have been using an EMR for 20 months now and my experience has been very similar to the 20 year Norwegian experience. My charts are now easily available to all my colleagues and I can access them form virtually anywhere in the world that has a high speed internet connection. However, the information is difficult to retrieve at times. Lab work is not consistently mapped to the flow sheet, so for tests that are somewhat unusual, such as an FSH, you have to go searching through all the lab documents. Also, the past medical history and family history do no appear on the patient summary sheet, so that can be a struggle as well. Every patient encounter is stored as a separate document that has to be opened separately. I find it takes longer at the beginning of a visit to review the last visit and any tests or consults the patient has had since.
I am doing more administrative work now. For example, pre-EMR, my assistant did my billing, now I do it.
Overall, I find that it takes a lot of time and effort to get all the data into the right "little box". However, if you don't, then you can't efficiently retrieve the information. I believe that I am spending an extra 30-60 min per day chaqrting at this point.

[Andre du Toit]

I my 4 years of using a full EMR I have also seen the shift in workload to the physician. It is sometimes faster to DO the task,like respond to a lab result, than to send a message to your MOA. The net result is that you run out of time and take work home, because you can...usually 45 min a day.

I am optimistic, however, that in the future that the MOA,physician model will be replaced by a Patient, MOA, Nurse, Physician encounter.
The story of the patient should be told by the patient ,if possible, and it should be my choice if I want to use it to populate the encounter. The same applies to the impressions of the MOA and nurse.
Nurses can preselect suggested templates for the encounter and also add vital signs.Most CDM visits can also be completed before you see the patient.

I would happily trade doing my own billing and rather let my staff spend time previewing my Dragon Dictate entries that always contain gremlins that I seem to miss.
e-Rx and communication channels directly to specialist and hospitals will be key in speeding up office tasks and allow for wider collaboration and efficiencies.

I may even have time to log into my Facebook account when I get home early!

[Ian Furst]

EMR since Mar 17, 2003 and the problem is that one inefficiency can make it miserable and the program will not/cannot be changed quickly. the other problem is that you're efficiency is as much (if not more) dependant on the network you've created as on the EMR you've selected. People get all hung up on which EMR with much less thought to the network structure. I'd suggest consider each equally. www.waittimes.blogspot.com