Zind B 2009 "Response to request for information by Barbara Zind, physician in a family practice, on August 3, 2009."

Reference
Zind B. Response to request for information (RFI) by Barbara Zind, physician in a family practice, on August 3, 2009. Agency for Healthcare Research and Quality; 2009.
Abstract
Dr. Barb Zind is part of a 14-pediatrician private practice in Grand Junction, Western Colorado. They had been using an EMR system for about 6 years when they switched to a new EMR system. Despite their ability to do electronic messaging and electronic prescribing, Dr. Zind feels the EMR is very inefficient. They can't yet electronically transmit lab and x-ray orders, and she finds she is doing many tasks that were previously done by others which adds to the length of her day. Some of the prescription templates are confusing to pharmacies.
Objective

To describe the experience of Dr. Barbara Zind, physician at a 14-pediatrician practice, in implementing a new electronic medical record (EMR) system.

Type Clinic
Primary care
Type Specific
Pediatrics
Size
Small and/or medium
Geography
Suburban
Other Information
The site was a self-run multispecialty group.
Type of Health IT
Electronic medical records (EMR)
Workflow-Related Findings
"Our original [EMR] is set up like a chart, there is a lot of free texting and so it was flexible. The downside of that EMR is the flexibility. As I could free text diagnoses, I could then not search for them later. This made it difficult to retrieve data. The support of the program was not very good either. I think because the diagnoses were not linked to any ICD9 code there was no billing advantage to the program."
"A few months [after implementing the new EMR], I was able to access our EMR at the local hospital. This made hospital care of our patients much better. I could verify their history and medications off site."
"The [second] program wasn't ready for our volume and was extremely slow. Taking about 30 seconds to bring up a note. That affected patient care. Some things [the training staff] didn't tell us - like to click on something after free texting a plan at the end of a note. [This] resulted in incomplete notes for about 6 months."
"The [second] program has so many bugs. A part of the program might be working great and then after an update it will stop working and I lose entire notes."
"It took 1 ½ years to get labs directly into the EMR and there was no backup plan. I was in dread of missing an abnormal result. We still don't have a direct interface with the lab orders. We have to print and fax the orders."
"The patient education handouts are not available yet. (It has been almost 2 years)."
"We have a voice recognition program but it is slower than typing. There is also a way to dictate only parts of a note into a template and that doesn't work."
"Overall there are so many options, desktops, buttons that it is overwhelming."
"Of concern is that there is no pediatric dosing check or calculator. The drug alarm comes up with every prescription so I don't even look at it. There is not enough flexibility with suspensions and so sometimes the prescription is in error. Many details in my prescription do not appear in the FAX that the pharmacy gets."
Study Design
Story
Study Participants
The participants included clinical and administrative staff at a private practice in Grand Junction, Colorado.