Monday, October 17, 2005

What is EMR?

What is EMR?

EMR is an anacroym for (E)lectronic (M)edical (R)ecords. EMR can actually cover quite a range of items. EMR can be an electronic wrist band containing a person's vital medical data. It can also be the complete set of "notes" your doctor records during your visit entered into a database during your visit. Taking paper records and scanning them into a electronic version is a form of EMR.

Benefits of EMR?

Our office went to EMR just over 5 years ago. We read all the info on how much money it will save and how much more efficient it will make the practice. "Leaving more time for patient care and less time spent on record keeping." I still see web sites touting these claims. As computers became more popular in just about every office setting; one claim was there would be less paper. Have we seen that?

Well from the previous paragraph you may conjure I'm not too fond of EMR's. Actually quite the contrary, I am very happy with the improvements after introduction EMRs in our practice. We do run more efficiently, and more time is spent with patients and less on record keeping. (Even though most third party payors have increased the requirements of paperwork.) But all of this came at quite an expense in both time and money. The initial expense of software and hardware at the start far outweighed any efficiency we saw. We did not fire anyone. Typically this is one of the line items that will "save" money with the switch to EMR. You will save the cost of one or two employees. While that was not our experience at the start, in fact we possibly could have hired more help, but we would not have fired anyone regardless. Contrary to the urban legend that computers are replacing jobs. What we did gain is a complete and reliable record of our patient visits. No more misplaced charts. Someone in the front of the office need to see the record? And then someone in the back (we have a large office), no problem. Or better yet someone in office A needs to discuss it with someone in office B (we have multiple locations). These are all possible with ease. Sunday morning Mrs. Jones runs out of her prescription? She doesn't know what it is. Again no problem with EMR. I won't even begin on the improvements in legibility of the records.

Problems moving to EMR?

One of most difficult to measure parts of the equation to establishing an EMR system is training. One of the problems is programmers don't think like doctors and doctors don't think like programmers. So what may be intuitive for one isn't to the other. Additionally neither likes change. Physicians make decisions all day long, some of them could be life or death, so there is a confidence in their process which is nurtured. Programmers create, and no-one likes when you criticize your "child". The result are systems that don't always mesh. A system that looks like it will "fit like a glove" doesn't always comply.

Standardization. Standardized EMR is an oxymoron. It's job security for the vendor not to have standardized formats. If anyone has every converted computer systems you know what I mean. This may be quite some feat as Ophthalmologists won't use an EMR system in the same way an Internist will use it. But some sort of standard record in an open source format (SQL?), needs to established. And then the eye doctor can interface with his portion of the record and the family doctor can do the same.

What's the Future?

Only about 20% of the medical field has EMR as of 2003. This will change but how quickly? Doctors recognize the need. Patient will require it. Who will foot the bill? Who will provide the "standardization"? Over the next 5 years 20% will double to over 50% is my predication, and close to 100% in 10 years. Just don't ask me how.

Saturday, October 15, 2005

What is an RSS feed?

What is a RSS feed? In it simplest and most common form you can think of RSS as a way to subscribe to a web page. Typically you "surf" to a web page read the content and move on. An hour, a day, a week, or a month later you may return to find the same content, or the other extreme, the entire site has changed. Checking a single web page on a regular basis isn't hard and isn't that disheartening when you return to find no updates. But the WWW is full of information, information that can literally change every second. In it's fullest sense you can use a RSS feed to deliver anything that can be broken down into discrete pieces. This blog is a prime example. The Podcasts I wrote about previously are delivered via a RSS feed. To keep track of the changes without having to visit every web page by hand and look to see what has changed, you can subscribe to the RSS feed. There are many other ways to use a RSS feed. You can have it feed a list of files that have been updated. There is a site called This site maintains a collection of programs for Unix, Palm and themes. If you subscribe to the RSS feed, you will automatically be updated with the newest files added to the site. (Just their names and descriptions, you won't be pulling down the whole program.) You can even receive email via an RSS feed here. To receive an RSS feed you need a RSS reader. There are quite a few out there. There available for all OS's and platforms. You can check out a few here. My favorite is NetNewswire Lite and you can't beat the price. If you're using Firefox, Firefox has a built in reader but calls them Livefeeds, rather than RSS or XML. Not sure what's out there to subscribe to? There are quite a few sites that have lists. is very complete. Are you still not sure? Just try it. As I said, there are a lot of free software packages out there you can download to try it. Even without software, you can use your Yahoo account to monitor RSS feeds. There are even RSS feeds about RSS! And if you're reading this with Firefox you're already setup with your Livefeeds!

Friday, October 14, 2005


Podcast: No entry found for podcast (is the response I got from Then I went over to and got: Podcasting is a method of publishing audio and video programs via the Internet, allowing users to subscribe to a feed of new files (usually MP3s). It became popular in late 2004, largely due to automatic downloading of audio onto portable players or personal computers. Wikipedia what a wonderful concept and COMPLETE. I'm not sure what the definition of popular is as I've asked some associates what a podcast is and they were unable to tell me, these were people in the computer "business". So I'm not sure how ubiquitous it is yet. Regardless it has grabbed my attention. I bought my first IPod about 2 months ago. I quickly transferred all my music and photos to it. I updated Itunes shortly thereafter, to find an entry for Podcasts on the menu. I found a Podcast that sounded interesting and downloaded it. My first Podcast was: TWIT and I was hooked. I also have a XtremeMac FM transmitter for my Ipod. I now could essentially program my own radio station. I have now built enough interesting Podcasts to fill all the time for my daily jog (is that term still used?) and the ride to and from work each day. What am I listenting to? Here's the list. You can find them all in the Apple store or you can goto their individual web sites: TWIT (This week in Tech) - This is basically a roundtable discussion of the latest trends in tech. Leo Laporte, Patrick Norton, Kevin Rose, John C. Dvorak and others. Note to TWIT: Show me where on your website where you have a synopsis of what the Podcast is about. The Mac Attack - The tagline here is: Mac tips, tricks, and hints you can use in your day to day computing! A pretty knowledge guy in NJ whos gives out tips on using your Mac. Nice explainations and useful stuff. The MacCast - Adam Christianson a "Mac Geek" as he affectionally calls himself. He lists the lastest news and comments and answers listener's questions. Inside Mac Radio - This a just about a daily Podcast with summary news throughout the week. On the weekend there's a much largier show posted. It's a copy of the actual broadcast of a talk radio show broadcast in San Jose. Lots of good info and opinions but a little on the commerical side. Diggnation - Again weekly. Kevin Rose and Alex Albrecht sit and review the top stories on I've added but then later deleted a few Podcasts, but the above are my favorites. Feel free to post your favorites and why.

Monday, October 3, 2005


When cars were introduced you needed to know just about every aspect about the car. Once upon a time you needed to know how the car operated, you need to know how to shift it manually. You needed to know not only how to shift it but when. Today you can get in your car and drive. Turn the key, turn the wheel, press the pedals. Posting to a web site, not just a page, but a whole site can be just as simple with software like WebGUI. With WebGUI running your web page you can "Add a page", "add an article", or add several other "object". Gone are the days when you have to crank start your engine. Granted you can still code HTML using Notepad, and you can buy car kits, but for most circumstances WebGUI has everything you'll need to complete an entire web site. And gone are the days when you have to know an entire new language to build a web site. You now can build it with pull down menus. There is a few systems like WebGUI. Drupal, Mambo, and PHP-Nuke are all well weathered systems. Want to try a working model of WebGUI? Check out this.

The Start of Something

This is my first official blog entry. To the extent that blogs have been increasing in leaps and bounds on the Internet, I would guess my first sentence can be almost be considered clich’e already. What can you expect here? I’m not sure what I’ll be posting. I’d like to make this an informational blog on several topics: medicine, ophthalmology, and computers. The topics may not be exclusive of each other and possibly I’ll mix the content. Hopefully I can share some information that will enlighten you and we can share and learn from each other. Comments can help guide the direction of this blog. Well onto my first entry…….