Thank you Carmella Steinke for asking

Thank you Carmella for asking your question.  But the three part answer I gave is a bit vague and wanted to expand on it a bit to better represent how critically important having a trusted employee manage the EHR is.  Also, I did not address the EHR generated alert or more specific alert issue.

The EHR generated alert issue most important for an internist is the section under Health Maintenance.  Based on gender, age and diagnosis codes, the EHR software intertwines the most current CDC immunization & US Task Force recommendations.  On the large screen TV at the visit we work through each of the vaccinations recommended, and also the ones up to date.  Also health maintenance items such as breast cancer, colorectal cancer, depression screening, exercise, diet, aspirin use, weight discussion, blood pressure monitoring, alcohol intake recommendations, tobacco cessation, abdominal ultrasound abdominal aortic screening are not only visualized but discussed during the wellness visit.  If any screening test is needed, I will send an order to my nurse as the patient watches on the TV screen.

The other type of alert an internist commonly deals with is making sure a followup test is ordered, such as ordering a CT in 3 months as requested by the radiologist for an abnormal finding. This is set by my nurse.  So while reviewing the CT scan report and CT images on the large screen TV at the appointment with the patient, I will send an order for a CT scan to be done in 3 months, again this process is visually confirmed by the patient.  My nurse will put a yellow alert which will pop up in 3 months to remind us both to order the CT.

Immediately at the end of the visit, my nurse will schedule the follow up office visit for 3 months, and will send the summary of the office visit through the patient portal reiterating the need for a followup Chest CT to be discussed at a visit in 3 months.

There of course is no perfect EHR, however as discussed in my original tweet, the most important part of this process is sharing all of this visually with the patient.  So by hearing and seeing all of the health maintenance items popping up on the large screen individualized both doc and patient may decide how best to proceed with the information at hand.

Also, for more specific alerts such as as the CT to be ordered in 3 months there are multiple steps to hopefully reduce error of not ordering or doing this.  The patient will not only see the radiology report, but review CT images with the doc, witness the order being sent, and have followup visit scheduled for 3 months.  When he arrives home there will be a summary reminding him of all of this in his email inbox.  And in 3 months both my nurse and I will see a yellow flagged reminder in our EHR inboxes to verify and confirm the Chest CT has been ordered.

I think one of the best decisions I have made in twenty one years of being an internist is sharing all of these alerts, steps and processes visually with my patients.  I think this is a better approach than the paper chart world, and if used properly the EHR can be an asset and not a hindrance in the primary care office.


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