Following my blog post last Friday where I threatened to take a drive to San Francisco for a demo of their software, Emily from Practice Fusion left this comment:

“No need for the road trip. You can get your own free EMR account with Practice Fusion in just a few seconds online here – https://pfws.practicefusion.com/apps/ehr/main.html?signup=true
Have fun testing it out. Feel free to reach out if you want more details.“

So I followed the link. The Practice Fusion site claims that any new user can be up and running within five minutes, i.e. “Live in Five”. They weren’t kidding. It only took me couple of minutes to get my login and password, and I off to the races.

The setup was incredibly simple and I found the user interface to be intuative and easy to use. It only took me a moment to get a new patient in the system and start creating a medical history. The Practice Fusion EMR uses a tabbed interface with clearly marked headers for Home, Schedule, Charts, e-Scripts, Messages, Documents, Reports and Admin. Below the primary tabs is a secondary set of tabs that gives the user access to online help videos, the recent activity of users, a “Community” area for additional information and a Marketplace where you can access consultants. However, once you enter the patient information area the secondary tabs disappear and you’re presented with nothing but a clean, unhindered user interface with easy access to your patients.

The medication section is pretty nice as you can easily search for a drug by simply typing in a few letters of the drug name and hitting ‘Enter’. The search works for both brand and generic name. The application even offers the ability to generate and send electronic prescriptions. This is a great feature. Electronic prescribing is a much better way of doing things as paper scripts often get lost, torn or forgotten.

As a pharmacist there are a couple of things I would like to see added to the medication area in Practice Fusion. First, there appears to be no cross checking between allergies and newly entered medications. I added a penicillin allergy to my patient and had no trouble ordering amoxicillin without any warnings. Second, I would like to see some clinical decision support around medication entry. There appears to be no clinical checking against coded diagnosis or the patients active medications. I was able to enter an amiodarone prescription on top of a warfarin prescription without warning. I assume that Practice Fusion expects individual pharmacies to police patient allergies and drug-drug interactions. While that is a reasonable assumption, it would be nice to see some kind of clinical chekcing in the application. Finally, I would like to see a more robust sig area within the prescription writer. I created some cool sigs while playing around with the app. I should say cool for me, but not for the pharmacist receiving them. I would have definitely received a phone call for clarification. With all that said, it is important to remember that the Practice Fusion application is not a pharmacy order entry system, is very robust and is available completely free of charge.

There are other modules available inside the Practice Fusion application, but I didn’t play with those as they had to do with insurances, billing, etc. Just not my cup of tea.

Pharmacists should take note of applications like the Practice Fusion EMR because it is clearly in their best interest. As pharmacists move into the medical home or into clinics to manage anticoagulation, hypertension, heart failure, weight loss and diabetes they will be exposed to EHR/EMR systems like Practice Fusion. They offer several advantages over legacy software systems and paper charting. Web-based medical records are the future of healthcare, so it’s best to just get used to the idea.

Oh, one other thing of note. I couldn’t view the Practice Fusion EMR on either my DROID or my iPhone; Flash issues. The application is easy to use from a desktop computer or a laptop, but it would be nice to use a smartphone to access your patient’s information in a pinch. Froyo, a.k.a. Andorid 2.2, is supposed to rectify issues with Flash. I’m looking forward to giving it another try once I update my DROID.

Throw in all the information above along with the fact that Dell and Practice Fusion have partnered to provide a ready made hardware solution to go with their EMR, and you’ve got a nice setup.

According to the Practice Fusion site:

The 1st Edition of Keys to EMR Success, was the HIMSS Book of the Year Award winner. In this revised Edition, nationally recognized expert Ron Sterling has included new chapters on EHR and Malpractice Risk, ARRA and Meaningful Use as well as detailed coverage of conversion issues for practices that have an old EMR.

“There is no question,” says Sterling, “that the selection and implementation of an EHR is a ‘bet-the-practice’ proposition. If you fail, you end up with more costs and greater frustration. Yet, few practices will be able to avoid implementing EHRs.”

I looked for the book in the usual places, i.e. Amazon, Barnes and Noble, etc. I found the first addition, but no luck on the second. I even had hopes of finding it in electronic format for the Nook, Kindle or even the iPad. Nope. So if you want to purchase the book you’ll need to go directly to the Greenbranch Publishing website.

While contemplating purchasing this book something occured to me. With the length of time it takes to publish a book, how relative would this material be to the current state of EHR/EMR implementation? Technology is moving at lightning speed. Maybe it’s time to consider a new way of disseminating information like this. Just a thought.

Most consumers don’t do a very good job of keeping track of their medications; much less the medication names, dosages, what they are used for and when they were last taken. It’s not uncommon on admission to the hospital for a patient to say things like “I take a blood pressure pill” or “a pain pill” or “a water pill”. As a pharmacist I can make gross generalizations about these medications, and can narrow the options down with aggressive questioning, but can rarely be sure without seeing the medication for myself.

The Electronic Health Record Incentive Program, a.k.a. Meaningful Use guidelines, calls for medication reconciliation to be used for at least 80 percent of “relevant encounters and transitions of care” (page 95). In addition “the capability to perform medication reconciliation is included in the certification standards for certified EHR technology.” This is easier said than done.

Most medication reconciliation begins in the Emergency Department. It is typically a manual system of information collected by nurses who in turn pass it off to the physician for approval. Unfortunately many physicians don’t take the time to scrutinize the medication list which is often inaccurate or incomplete.

The ideal list of medications currently being taken by a patient wouldn’t be generated by the patient at all. Instead the list would be downloaded from a nationally standardized e-pharmacy. Of course no such thing exists, but that doesn’t mean it shouldn’t.

In theory all medications taken by patients are filled in a pharmacy, whether that is a chain pharmacy, community pharmacy or mail order pharmacy. Modern pharmacies are computerized and connected to the internet so that insurance adjudication can take place. The same data should be transmitted to a centralized e-pharmacy where it would be stored and accessed by hospitals during patient admissions. The list would follow the patient throughout their admission and be finalized on discharge. After all, the medication use profile is never more accurate than at the time of discharge.

In the absence of a centralized e-pharmacy, several vendors offer software applications designed to help hospitals maintain a digital medication reconciliation record. Most of these applications can be integrated into the pharmacy information system, making the process a little easier. The solution is not ideal, but it is better than a manual system with pen and paper.

Some vendors that offer medication reconciliation software are listed below.

RxReconcile
MedsTracker
RcopiaAC
MediRec
Mediware’s ClosedLoop Clinical Systems
HCS Medication Reconciliation

While the idea is sound, the implementation has something to be desired. The overwhelming attention to the definition of “meaningful use” and the looming 2011 timeline has created some unwanted side effects to the ARRA. Hospitals have started throwing project plans in reverse for significant revision or throwing them out the window and starting over all together. Projects that may have been in the pipeline for months, or years, are now taking a back seat to the ARRA requirements. Project development and timelines are involved processes that are designed to work around several variables such as capital budgets, current software and hardware specs, and available human resources.

Many healthcare systems have yet to develop a plan to implement many of the requirements necessary to meet the ARRA “meaningful use” criteria. If a healthcare systems wasn’t ready to begin the process at any time over the past several years what makes the US government think they’ll be ready just because they say so? Is the infrastructure in place? Do they have the resources to not only implement, but support the new systems as well? These are all questions that people should be asking. I for one am disappointed in our facility as we have decided to immediately move forward with projects that weren’t slated for another 18-24 months. To make this happen other projects have been placed lower in the priority queue, creating a lack of resources that risk jeopardizing the quality of both implementations.

Healthcare systems should not be directed down a path that they feel unprepared to face. Doing so will only invite failure.