Becoming an ePhysician

Being an effective manager of information is a central task for family physicians, yet many ignore the most powerful information management tool ever invented: the computer. This month’s issue of JFP features several articles that describe how family physicians have begun to integrate information technology into their practices. Couchman and colleagues1 found that most patients expected their physicians to use E-mail, and wanted to use it to get prescription refills, test results, and the answers to routine medical questions. Particularly interesting was the expectation of speed: 3 out of 4 expected to get laboratory results within 24 hours.

In a second study, Campbell and coworkers² report their experiences of introducing computer and telemedicine technologies to physicians in rural Missouri. They met with varying degrees of resistance and wisely suggest tailoring the approach to the setting. When working with sites that are more skeptical of change, you have to first justify the need for technology, and then convince physicians that it can make their lives easier and improve the care they deliver to patients.

Implementing an outpatient electronic medical record is an expensive undertaking that can reduce, rather than enhance, productivity. Three strategies can reduce the risks of making the transition to an electronic medical record. In a guerilla strategy, individual physicians buy hand-held computers, run network cable in the middle of the night, and experiment with wireless communication. This can be disruptive, but it is also a good way to build interest among other physicians and gain experience with new technologies. After all, it is difficult to stop a determined computer geek. In a pilot strategy, one clinic in a group of clinics or one department in a multispecialty group adopts an electronic medical record. The guinea pigs should include technologically proficient physicians who can serve as peer role models, and if possible the rollout should take place during a slower clinical period, such as the summer. The experience gained can then be used to facilitate adoption of the system in other sites.

Finally, a halfway strategy shifts some but not all clinical tasks to an electronic system. Fox and colleagues³ describe one such strategy in their article on handheld electronic prescribing systems, and the enthusiasm of these family physicians is infectious. The great thing about hand-held prescribing systems is that they do not involve a major paradigm shift: You are still writing prescriptions on a small flat object. Now, however, you also have drug information, formularies, and the patient’s current medication list at your fingertips. Most physicians can learn to use them in 15 minutes, and they can immediately improve the quality of care. With the recent attention on medical errors and patient safety, these systems are a no-brainer.

So where can you begin? Get an E-mail account and use it. Throw away your planner and buy a Palm, Visor, or PocketPC hand-held computer.⁴ Load it with cheap and useful medical information; upcoming articles in JFP will highlight free software for these systems. Learn how to use a Web browser, and bookmark 10 really helpful medical sites, like the JFP Web site (www.jfponline.com). Start thinking about electronic medical record systems: Learn about their features, vendors, and what questions to ask.5 Years from now, saying that you do not use a computer will sound as strange as saying that you do not use a stethoscope. It is time to get started.

Being an effective manager of information is a central task for family physicians, yet many ignore the most powerful information management tool ever invented: the computer. This month’s issue of JFP features several articles that describe how family physicians have begun to integrate information technology into their practices. Couchman and colleagues1 found that most patients expected their physicians to use E-mail, and wanted to use it to get prescription refills, test results, and the answers to routine medical questions. Particularly interesting was the expectation of speed: 3 out of 4 expected to get laboratory results within 24 hours.

In a second study, Campbell and coworkers² report their experiences of introducing computer and telemedicine technologies to physicians in rural Missouri. They met with varying degrees of resistance and wisely suggest tailoring the approach to the setting. When working with sites that are more skeptical of change, you have to first justify the need for technology, and then convince physicians that it can make their lives easier and improve the care they deliver to patients.

Implementing an outpatient electronic medical record is an expensive undertaking that can reduce, rather than enhance, productivity. Three strategies can reduce the risks of making the transition to an electronic medical record. In a guerilla strategy, individual physicians buy hand-held computers, run network cable in the middle of the night, and experiment with wireless communication. This can be disruptive, but it is also a good way to build interest among other physicians and gain experience with new technologies. After all, it is difficult to stop a determined computer geek. In a pilot strategy, one clinic in a group of clinics or one department in a multispecialty group adopts an electronic medical record. The guinea pigs should include technologically proficient physicians who can serve as peer role models, and if possible the rollout should take place during a slower clinical period, such as the summer. The experience gained can then be used to facilitate adoption of the system in other sites.

Finally, a halfway strategy shifts some but not all clinical tasks to an electronic system. Fox and colleagues³ describe one such strategy in their article on handheld electronic prescribing systems, and the enthusiasm of these family physicians is infectious. The great thing about hand-held prescribing systems is that they do not involve a major paradigm shift: You are still writing prescriptions on a small flat object. Now, however, you also have drug information, formularies, and the patient’s current medication list at your fingertips. Most physicians can learn to use them in 15 minutes, and they can immediately improve the quality of care. With the recent attention on medical errors and patient safety, these systems are a no-brainer.

So where can you begin? Get an E-mail account and use it. Throw away your planner and buy a Palm, Visor, or PocketPC hand-held computer.⁴ Load it with cheap and useful medical information; upcoming articles in JFP will highlight free software for these systems. Learn how to use a Web browser, and bookmark 10 really helpful medical sites, like the JFP Web site (www.jfponline.com). Start thinking about electronic medical record systems: Learn about their features, vendors, and what questions to ask.5 Years from now, saying that you do not use a computer will sound as strange as saying that you do not use a stethoscope. It is time to get started.

Being an effective manager of information is a central task for family physicians, yet many ignore the most powerful information management tool ever invented: the computer. This month’s issue of JFP features several articles that describe how family physicians have begun to integrate information technology into their practices. Couchman and colleagues1 found that most patients expected their physicians to use E-mail, and wanted to use it to get prescription refills, test results, and the answers to routine medical questions. Particularly interesting was the expectation of speed: 3 out of 4 expected to get laboratory results within 24 hours.

In a second study, Campbell and coworkers² report their experiences of introducing computer and telemedicine technologies to physicians in rural Missouri. They met with varying degrees of resistance and wisely suggest tailoring the approach to the setting. When working with sites that are more skeptical of change, you have to first justify the need for technology, and then convince physicians that it can make their lives easier and improve the care they deliver to patients.

Implementing an outpatient electronic medical record is an expensive undertaking that can reduce, rather than enhance, productivity. Three strategies can reduce the risks of making the transition to an electronic medical record. In a guerilla strategy, individual physicians buy hand-held computers, run network cable in the middle of the night, and experiment with wireless communication. This can be disruptive, but it is also a good way to build interest among other physicians and gain experience with new technologies. After all, it is difficult to stop a determined computer geek. In a pilot strategy, one clinic in a group of clinics or one department in a multispecialty group adopts an electronic medical record. The guinea pigs should include technologically proficient physicians who can serve as peer role models, and if possible the rollout should take place during a slower clinical period, such as the summer. The experience gained can then be used to facilitate adoption of the system in other sites.

Finally, a halfway strategy shifts some but not all clinical tasks to an electronic system. Fox and colleagues³ describe one such strategy in their article on handheld electronic prescribing systems, and the enthusiasm of these family physicians is infectious. The great thing about hand-held prescribing systems is that they do not involve a major paradigm shift: You are still writing prescriptions on a small flat object. Now, however, you also have drug information, formularies, and the patient’s current medication list at your fingertips. Most physicians can learn to use them in 15 minutes, and they can immediately improve the quality of care. With the recent attention on medical errors and patient safety, these systems are a no-brainer.

So where can you begin? Get an E-mail account and use it. Throw away your planner and buy a Palm, Visor, or PocketPC hand-held computer.⁴ Load it with cheap and useful medical information; upcoming articles in JFP will highlight free software for these systems. Learn how to use a Web browser, and bookmark 10 really helpful medical sites, like the JFP Web site (www.jfponline.com). Start thinking about electronic medical record systems: Learn about their features, vendors, and what questions to ask.5 Years from now, saying that you do not use a computer will sound as strange as saying that you do not use a stethoscope. It is time to get started.