I am very excited about the prospect of bringing the new found power of a 'database' into my practice. On January 11, a Friday, I finished seeing patients and was clearing my desk. I was pitching the 'throw aways' in the trash when "Cortlandt Forum" caught my eye. "A deadly diabetic complication" was an article about subclinical presentation of Lactic Acidosis. In elderly patients with impaired renal function this may go unrecognized as weight loss or weakness. Of course this could be a large number of my patients.
So I began my first introduction to the "search" function in AC. Out of 5,300 active charts I found 242 patients taking metformin, and then I manually opened those, beginning with the oldest, and reviewed 5 criteria. (CC, graph of weight, Dx, labs, and absence of Labs in the past year) I forwarded about 22 patients to my associates or myself, and of mine, I called two that night to have them stop the drug.
When speaking with Doctors at the state Osteopathic meeting I encouraged them to move into the EMR, and to imagine the DATABASE as a large lump of clay, sitting off to the side. Face to face time with patients is really only impacted in a business sense, (filing is complete, records are accessible and legible), but the dramatic change to me is this database, this lump of clay that you can return to when you have new or better knowledge and you can mold or shape into a better, healthier practice.
Coming to understand this vision of the future of my practice I have been enable to infect the director of the IPA which handles all of our managed care patients. He is willing to talk with me about a joint effort to make the practice healthier, and of course more profitable for the IPA. If we succeed, we will have demonstrated value added, (sculpting that lump of clay) and they will reward us with a higher capitation rate. Time will tell if any of this can work, but my optimism is extremely high.
