You can now add Notifications, and EMRian will remind you about your appointments with your patients.

Here’s how you do that:

There is a checkbox on “Schedule Appointment” Window:

After checking the checkbox, another window will open, where you will choose how you want to get notified: via e-mail or via instant messenger, when you want to get notified, and just click on “Submit”. The screenshot below shows the Notification window.

Let’s view all the different ways you can schedule appointment using EMRian.

1) You are on the Schedular Page. From Daily View you can click on “Add Appointment” link.

The following New Appointment window allows you to enter the most relevant information for patient meeting.

2) You can also double click on the calendar and you will again be directed to the Appointment window to make your entry.

3) Schedular Weekly and Monthly views respectievley allow to add new visits for patients with the same convenient window.

4) You can also schedule appointment for the patient when you are in the patient encounter section. There is a link there that will direct you the the New Appointment window.

5) And finally you can schedule the appointment right after new patient registration with a covenient wizard.

The idea of recording patient information electronically instead of on paper –the Electronic Medical Record (EMR) –has been around since the late 1960’s, when Larry Weed introduced the concept of the Problem Oriented Medical Record into medical practice. Until then, doctor’s usually recorded only their diagnoses and the treatment they provided. Weed’s innovation was to generate a record that would allow a third party to independently verify the diagnosis. In 1972, the Regenstein Institute the Indiana University School of Medicine, developed the first medical records system. Although the concept was widely hailed as a major advance in medical practice, physicians did not fly into the technology (http://www.medrecinst.com/uploadedFiles/MRILibrary/StatusReport.pdf). In 1991, the Institute of Medicine in the US recommended that by the year 2000, every physician should be using computers in their practice to improve patient care and made policy recommendations on how to achieve that goal (http://www.medinfo.ufl.edu/omi/docs/olmr/cpri.html).

However, it is estimated that EMR use is about 20% in the hospital sector in the US (less in Canada) and about 5% in clinics (probably about the same in Canada). Some studies report the major barriers to widespread EMR implementation. They analyze different criteria, among which the major ones are: the cost of EMR purchase; the adaptation time; the length of a patient encounter; the time required to record the encounter, etc.

Here are some data findings:

• Most patient encounters last about 7-10 minutes
• Typically 25% of the time is spent in documentation
• Physicians record an encounter in about 2 minutes
• current methods of data input are slow and tedious
• They need systems which are easy to use and which don’t require long learning curves
• Given current costs of about $10-20K per year, there is a long way to go to get to an acceptable price
• Inability to recoup investments in technology.

It appears that market suppliers do not make a distinction between physician needs and health care system needs. Although we expect that the two markets are likely to move alongside, they are different and distinct markets. Major customers for EMRs that are being developed with large amount of functionality and complicated methods of data input will not be physicians as they are only small beneficiaries of these systems. These current systems are about what to do, but not about what patient information is most relevant, what providers need to know to deliver good care.

The on-demand systems such as EMRian http://emrian.com aim to solve the above issues, by providing 1) Low Total Cost of Ownership TCO (you pay for the features you need); 2) Simple and comprehensive data input system; 3) No initial capital investment and no maintenance and upgrade fees.

EMRian provides medical practice management service for individual doctors, solo and small family and group practices, general practitioners, community clinics and for those medical care providers for whom cost is the main barrier to adapt computer-based patient medical record technologies.

EMRian is on-demand Medical Practice Management Suite…

But wait! There are hundreds of such tools. What’s the difference? Here how we want to differentiate. We want EMRian to be your tool to make your work easy, simple and friendly.

EMRian is:

EASY, means it takes a lot of burden off from your shoulders when you choose EMRian:

• Takes less than 5 minutes to start
• No upfront cost
• No cost at all if you choose free version
• Upgrade is another 5 minutes process
• You do not pay any maintenance fee
• No hardware and installations needed
• On-going updates and improvements without interruptions

SIMPLE, means you will have no problem of using the EMRian features:

• EMRian is not cluttered with 100s of features you do not need
• Your can suggest feature that you need by simply sending us a feedback (see Help)
• No lengthy training are necessary

FRIENDLY, means we make the interface please you:

• It shows what you want to see and use and doesn’t overwhelm you
• It helps you by reminding about things you need to do
• It provides you overall “report” of your daily hard work on one dashboard

EMRian features are what you do on your daily work. You COMMUNICATE! You communicate with your patients, with your peer doctors, with your nurse, laboratory doctor, and you need them all for better and full service.

EMRian features are designed for you to communicate in order to make your practice successful.

EMRian is in beta release. We expect your active participation to make EMRian your own practical tool to manage your care providing practice. Please use our simple “Feedback” feature to bring your opinion to our brainstorming board!

You need to log in to be able to provide feedback.

When you are already logged in then just click on “Feedback” from the top menu in EMRian.

You will see a small pop-up:

Type in the field what you want and not want in EMRian, and click on “Submit”. And your opinion will appear on our “plate of contemplation”!

In our last post we talked about identitification of a user at the access point: http://blog.emrian.com/?p=51#comments by use of passwords. Because of the sensitivity of patient data, users of any electronic records system who had not “proven” at the point of access that “they are who they are” must be prevented from access.

When the user had proved who he is now the question is “What can he do?” Can a valid user who had been authenticated, see EVERYTHING on EVERYONE? The users who do have authentification, must be determined by the system what data they are allowed to access and what functions can be performed by the user on that data, e.g., to view, copy, or update data. This is authorization issue. Though the differences among these questions are relatively simple, they are often confused in the literature. It is critical that any electronic health records system that implements health common framework addresses this issue.

Authorization could be user-based: that is authorization rights based on who an individual is so that he/she be associated with the audited actions; role-based; that is, the different operations available are tied to the role of the user, e.g. doctor vs. nurse vs. lab technologist vs administrative support, etc.; Context Based that is “Who you are (user) + What you are (role) + Where you are + When you are”.

System should not prevent doctors providing care. Authorization in many cases is based on relationship to the patient. Provider must be accountable for how that information is used or misused. Providers declare a relationship when a patient is accessed. Person-provider-activity is logged for audit.

What have passwords do with protecting patient privacy and securing of health data and comply with HIPAA?

Health Insurance Portability and Accountability Act (HIPAA) was issued to assist in the portability of health insurance and to reduce the administrative cost of healthcare. The enhanced availability of health information in an electronic format to improve the quality and reduce the cost of healthcare, arises concerns about greater risk for loss of privacy among health care participants.

Meantime, one should be sure, that paper records could also be abused and misused by anyone in a white coat, and no one would ever know. And it starts from having access to the data you are not authorized to. With electronic records, there can be “audit trails,” who tried to access to which data. Passwords are the simplest form to authentify users and perform control at the access point. They ask to knonw whether “You are who you are”. Passwords can be very secure, can even be too secure – if are forgetten.

Strict enforcement of “password policies” with detailed audit logs will manage user access and account activity. Passwords control authentication attempts and will show who accessed the information and will control not authorized accesses. When time out (say, in 5-10 minutes inactivity the session is automatically being logged out) on computers they require re-entry to log in.

Use different useful tips how to choose stront passwords: e.g. http://www.auscert.org.au/render.html?it=2260, http://www.securityfocus.com/infocus/1537 http://www.tech-faq.com/passwords.shtml.

EMRian is now available for Internet Explorer! Some minor bugs have been fixed, some updates regarding user profile have been made and a new version of EMRian has been released. Please, feel free to test the system and notify us on any noticed bug! Thank you for using our system!

There are two ways you can create EMRian New Encounter.

1) When you have scheduled appointment with your patients, before they are released, you will see them all on your home page:

Under column “Action” you see options: “Accept” and “Edit”. “Accept” means that this patient does not have open encounter, and by clicking on “Accept” a new encounter will be opened for this patient. “Edit” means the patient has open encounter, and you can edit it.

Clicking on “Accept”, you open encounter for the patient, see below:

2) Second way to open New Encounter is by clicking “Open Encounter” link from the patients’ list in “Patients” module.

Once the new encounter is opened, you can start adding patient’s illness history to be attached to that encounter. There are 2 features now at EMRian to enter patient’s clinical hostory: Notes and Attachments.

For creating Note, you need to click on “Add Note” on the Encounter page.

Note has a Title and Discription. You can add free text in the Title and Description fields and save it by clincking on “Submit”. When the Note is saved, it can be edited, viewed and deleted. Last edit date is saved for your reference. You can have unlimited number of Notes attached to one encounter.

To attach documents, you need to click on the “Attachment” tab. You will see “Attach new” button. When you click on that button, you will have the following window:

You”Browse” for a file you need to attach and then click on “Submit”. The document will be attached to the patient encounter for future reference.

NOTE: Attachment feature available for a month during beta testing period. After that attachments will be allowed for EMRian Solo, Small, Medium and Large Group Packages only.

Electronic medical records (EMR) systems are important productivity tool for doctors. Implementing EMR can be one of the most beneficial things you can do for your practice’s success. Although it is not easy to find the right product which will meet both specific practice requirements and budget.
At one point we counted over 250 different EMR systems that exist in the market. With this enormous list there are also different “help guides” to assist buyers to choose the best EMR to suite their needs and meet their budget line. The time required to do the appropriate EMR review, makes evaluating EMR’s too overwhelming. It’s difficult for the individual doctors, small practices, general practitioners, community clinics to make these kinds of investments.

The rate of EMR use in physician practices is estimated at 20%. Cost is the main barrier to EMR implementation, as cited by 86% of the hospitals responding”. American Hospital Assn. study, “Continued Progress: Hospital Use of Information Technology,” Feb. 27, 2007 (http://www.ama-assn.org/amednews/2007/03/19/bicb0319.htm ).While the quality improvement benefits of an EMR are promising, the study suggests little hope for EMRs to have any financial benefit for community clinics. And even though the clinics might not be focused on the financial return on investment, instead focusing on improved patient care, just getting financing to start the project is “a burden too great for many community clinics to bear”. The study found that only 11% of community hospitals have fully implemented EMR systems, while 57% have “partially” implemented systems and 32% have not started.

There are no empirical data or surveys measuring how many de-installs occur annually, but people in the industry estimate that 20% to 33% of EMRs fail within a year of their implementation because physicians are unhappy with the systems. With industry estimates showing that up to 80% of practices have not yet made the EMR leap, there are a lot of first-time buyers who could fall into the de-installation trap.

On-demand web service may help to overcome the above problem, when doctors can subscribe and start using the system in 5 minutes. Web service doesn’t require having upfront investment and sophisticated IT staff. Moreover the service provider also takes care about security, archiving and maintenance. Services like EMRian are well-suited for small practices and doctors.