One example where the EMR can really make a difference in outcomes

Given all the complaining I and my colleagues do about the problems with the EMR, I figured I’d take the opportunity to tell you about something good that came from having my practice online.

A patient came to see me last week for a check up and requested a prescription for birth control pills.  She’d used them in the past without problems. I wrote the script and sent her on her way.

As I was finishing writing her visit note later that afternoon, I did what I usually like to do but had not had time for while she was in my office –– look through her last few visits in the system with other docs. I noticed that she had had a recent CT scan for abdominal pain, something she had forgotten to tell me when I asked about interval medical history. A small presumed angiomyolipoma had been found on her kidney, and was being watched.

I seemed to remember that there was something about angiomyolipomas that could be problematic with hormones. A quick foray into UptoDate and Pub Med reminded me that these tumors, though benign, have receptors for estrogen and progesterone, and have been reported to grow, sometimes rapidly, in pregnancy and on birth control pills.

I immediately called my patient to discuss the issue, and advised her not to fill the prescription I had given her for birth control pills. She would continue to use condoms while considering a copper IUD for birth control. I updated her problem list and medical history to include the CT finding, so that the next doc to see her would find the issue up front instead of fortuitously stumbling onto it while poking around her chart after the visit was over.

This is actually not the first time I’ve happened upon clinically critical information in the EMR that my patients have forgotten to tell me. It’s the one area where the EMR can really make a difference in outcomes.  Of course, this only works when patients have a small enough record, as my patient did, for me to poke around in a few seconds, and best when providers write concise, relevant notes (something the EMR does not facilitate) and update the history and problem lists accordingly.

I’m sure one day someone will figure out a way for that kidney tumor diagnosis to automatically warn me when I go to prescribe birth control pills, but for now I’m happy just to have access to all my patient’s information in one place.

Margaret Polaneczky is an obstetrician-gynecologist who blogs at The Blog That Ate Manhattan.

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