STAT! Systems
E L E C T R O N I C  M E D I C A L  R E C O R D S

EMR Challenges and Promises

System helps realize potential of electronic records

By Ronald Leemhuis, M.D.

Improved technologies and increased expectations for medical records have led to the development of computer programs for managing patient records. While some practices have implemented successful electronic medical records (EMR) systems, the use of such systems has fallen short of expectations. Proponents of computerized patient records may wonder why such promising technology goes unused….

Q.D. Clinical from STAT! Systems, Inc., in Berkeley, California, is one medical records program suited for use on ordinary personal computers in stand-alone and networked configurations. Originally developed and widely accepted in its DOS version, Q.D. Clinical was enhanced and upgraded to a Windows version in 1997. Together, the DOS and Windows version have sold thousands of copies.…

Barriers to implementing electronic medical records are, at this point, more behavioral than technological. This report documents how two users of electronic medical records perceive the barriers to successful implementation….

When I describe Q.D. Clinical and its capabilities, I speak from personal experience. I began using Q.D. Clinical in April 1993, and I upgraded to the Windows version of Q.D. Clinical in July 1999. Since 1993, I have recorded nearly every office visit in Q.D. Clinical. Like other specialized database applications, Q.D. Clinical interacts with a human: It records, catalogs, and stores information. In the case of patient encounters, such information includes patient demographics, medications, allergies, laboratory test results, treatments, medical history, physical findings, diagnostic impressions and treatment plans….

I have yet to meet a colleague unimpressed by the capabilities and output of Q.D. Clinical…. As an experienced user of the electronic medical record, I cannot imagine returning to handwritten or dictated charts. I have come to rely on the computer program to prompt me for health maintenance interventions, to organize progress notes, to print prescriptions and to check for drug interactions and allergies….

We have tried Dragon Naturally Speaking Preferred, a voice recognition program, with Q.D. Clinical. Dragon works very well to dictate a progress note into a single "Progress Note" field, or into any other field using a quick cut-and-paste technique. Dragon also allows the use of a hand-held device for dictating on the move….

In conclusion, current technology allows relatively inexpensive implementation of electronic medical records in a small medical practice. Implementation, however, is limited primarily by the commitment of the physicians using the system and their flexibility in learning and using various methods of data input. Successful methods of data entry include direct typing by the physician, dictation and transcription, use of voice recognition software and point-and-click text generation through the use of query lists, clinical macros, phrases and defaults….

Learning to navigate Q.D. Clinical and to enter patient information requires one to learn new methods. Motivated physicians may successfully use one or more of these methods to enter narratives into the record. The true power of Q.D. Clinical is harnessed by the physician who develops and customizes query lists, macros, phrase lists and defaults for the ease of point and click entry at the actual site and time of encounter….

The promises of electronic medical records will be fulfilled if physicians commit to learning and implementing such new methods. I recommend that every medical practice consider using Q.D. Clinical.