The Electronic Medical Office

This document is intended as a checklist for physicians that want to set up a partially or completely electronic clinic and are either just starting or converting from a paper-based system. An electronic system is a major investment but with proper planning will lead to the desired increase in efficiency.

1. EMR (Electronic Medical Record) software

What EMR software to use should be the first consideration when deploying an electronic system. While there are many systems available, a company with British Columbia experience is essential for proper integration with local entities such as MSP Teleplan, Excelleris, and Medinet. Deciding factors should be functionality, performance, easy-of-use, vendor market share, and cost. Please talk to us for more information.

2. PITO (Physician Information Technology Office)

PITO is an initiative of the provincial government and the BCMA to support physicians preparing for and adopting EMRs by providing up to 70% reimbursement of the up-front and on-going costs of installing and maintaining an EMR. The following EMR vendors currently qualify for PITO funding: Intrahealth, Med Access, EMIS, Osler systems, and Wolf Medical. Participation in the PITO program requires the adoption all PITO standards. While not every office decides to implement the PITO solution, SupportLINK has a working relationship with PITO and can assist with the installation of a PITO solution.

3. Infrastructure

SupportLINK will ensure the office has the required infrastructure to support the new EMR. We will review available electrical and data lines and install additional outlets if required. We will also review the work areas and install LCD wall-mount brackets and keyboard trays if needed.

4. Hardware

Stable hardware is critical for a successful implementation. SupportLINK has many years experience with hardware compatibility for medical software. SupportLINK also has working relationships with EMR vendors to ensure the software will be compatible with the hardware.

5. Internet connection

For PITO implementations, the Internet connection is supplied and funded by PITO. For non-PITO implementations, we recommend Telus ADSL. The connection is required for MSP Teleplan fee code uploads, lab results downloads, e-mail, and software updates.

6. Firewall protection

For PITO implementations, firewalling is provided. For non-PITO implementations, SupportLINK will ensure adequate protection of the network.

7. Anti-virus

Depending on the size of the clinic we recommend either stand-alone anti-virus packages or centrally managed solutions. Please talk to us for a recommendation.

8. Data backup

SupportLINK has experience with medical data protection for smaller clinics as well as hospitals. The data backup solution and strategy varies depending on circumstances, but typically, we will set up a system that will

1. automatically backup every night,
2. keep a history of backups ranging several weeks backwards,
3. allow for disaster recovery within a few hours
4. protect from events such as fire, flood, and theft.

Most offices that we first visit fall short of maintaining this kind of backup system and problems often go unnoticed until a failure occurs. Please talk to us. We are protecting millions of dollars of business data every day.

9. Electronic Faxing

For incoming faxes, the system can be configured to automatically convert the fax to a PDF or TIF document and save it into a folder where it can then be attached to the electronic patient chart.
For outgoing faxes, we recommend a multi-function fax machine that can be used for both paper faxing as well as electronic faxing. Not all electronic fax machines will support faxing from all workstations, and not all fax machines are compatible with all EMR software. Please talk to us before purchasing a fax machine.

10. Scanning

A high-speed scanner is required for scanning paper documents. The system can be configured to automatically convert the document to a PDF or TIF document and save it into a folder where it can then be attached to the electronic patient chart.
If the office is converting from paper to electronic charts, it may not be necessary to convert all paper charts. Instead, a good solution may be to have the MOA periodically preview the day sheets for the next two weeks and scan the charts for only those patients that will be seen, thus avoiding the labor of scanning inactive charts.

11. E-mail, Calendar, Contacts: sharing and synchronization

The EMR day sheets and contact list are typically not suitable to store personal and non-clinical appointments and contacts. We recommend Microsoft Outlook in conjunction with Microsoft Exchange for this purpose. E-mail, Contacts, and Calendars can be shared among office staff with selective access permissions for each user. The information can also be synchronized with mobile devices such as laptops, IPhones, Blackberries, and other smart phones. SupportLINK has experience setting up this solution for offices ranging from 5 to 200 employees.

12. Electronic Dictation

There are three options.

1. Voice recognition software. Using a microphone, the physician dictates the consult letter and the software will do the transcription. Accuracy varies, and some manual steps are required (open the patient chart, select the template, dictate, then save). A transcriptionist is not required.
2. Macros. Keyboard shortcuts are used to automatically populate frequently used phrases and paragraphs. This option requires some keyboard typing and the same manual steps are required as with option 1. A transcriptionist is not required.
3. A transcriptionist. An electronic voice recorder (it looks similar to the old magnetic voice recorders) is used to record the dictations. The voice files are then electronically sent to the transcriptionist who can be working outside of the office. The transcriptionist will then remotely connect to the EMR, open the patient chart, select the template, transcribe the voice files, save the letter and electronically fax it to the referring doctor.

13. Remote access

We set up a secure connection to the office from essentially any PC or laptop with an Internet connection. Look up a patient record from home without going the office or finish your consult letters remotely.

We hope this information provides insight into the possibilities of an Electronic Medical Office. Please contact us for any questions.