Doctors design a free, downloadable medical record

Its creators say it's good for a primary care practice, although the programmer says it's no substitute for full automation.

By Tyler Chin, amednews staff. April 8, 2002.

Fed up with how long it took to chase down and manually go through paper charts, physicians at Moses Cone Family Medicine Residency Program decided that they had to find a better way to meet demands for quality improvement and assurance.

So, the Greensboro, N.C., residency program in 1999 designed a miniature electronic medical record that can be downloaded off the Web. It lets physicians automate critical clinical information and more easily conduct quality interventions and audits without having to buy an expensive EMR.

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"It's mostly for adult primary care, but any physician could use it for free and modify it," said M. Lee Chambliss, MD, assistant professor at the residency program with Moses Cone Health System and the University of North Carolina at Chapel Hill Dept. of Family Practice. He also is the lead author of an article about the residency program's implementation of the "mini-EMR" in the December 2001 Journal of Family Practice.

Based on the Microsoft Access database program, the mini-EMR is a hybrid of paper and computers. It has an electronic face sheet that captures demographic data, medications and dosages, chronic problems, diagnoses and ICD-9 codes.

Staff print and attach this face sheet to the front of the chart before the patient's visit, giving physicians quicker access to key information, Dr. Chambliss said. The system also alerts physicians when it's time for preventive services, such as mammograms, Pap smears or flu shots.

When doctors dictate their notes, they also add new medications, problems and dates of preventive services.

More than 200 physicians have downloaded the program.

The family medicine group of 31 faculty and resident physicians rejected commercial EMRs because the systems were too costly. In contrast, the mini-EMR didn't cost anything other than time, because the program already had the software, hardware and an in-house physician who could do the necessary programming.

Also, the technology of off-the-shelf EMRs is still relatively immature, Dr. Chambliss said. "This is very much thought of and intended to be a bridge program until we find an EMR that meets most of our needs and that market matures."

Wide physician acceptance

So far, all physicians, including those wary of technology, have accepted the system, which the group implemented in May 2000.

"It does a lot to help us do quality interventions that every practice should be doing and that the accrediting bodies ... want to see," said William A. Hensel, MD, clinical professor at the residency program. "This is a tool that actually saves time and allows me to take better care of patients."

For example, when he refers a patient to a specialist, all he has to do is type a brief explanation and print the referral form, giving the consultant a highly readable medical history, Dr. Hensel said.

Peer pressure also played a key role in influencing physicians to adopt the new system, Dr. Hensel said. Early users would say, "Well, I admitted one of your patients to the hospital last night and they hadn't been entered into the EMR. I had to hand write all that stuff. Get your patients entered."

While doctors at Moses Cone have found the mini-EMR useful, it doesn't work for everyone, said Robert D. Clark, MD, a solo family physician in Linville, N.C., who wrote the program when he was a third-year resident.

The mini-EMR "works grand" for physicians who are paper-based and don't want to automate, Dr. Clark said. But he opted for a commercial system when he went into private practice in 2000 because he didn't want to have a paper-based office.

Since December 2001, more than 200 physicians have downloaded the program, including J. Todd Wahrenberger, MD, a family physician at a five-doctor group in Pittsburgh.

Dr. Wahrenberger had been using speech-recognition software to dictate notes into a Microsoft Word document that could not be searched electronically, he said. But with the mini-EMR program, he dictates into searchable Microsoft Access text fields.

"It makes it easier to find notes in our office," Dr. Wahrenberger said.