Ten Things I Love About the LMR

First, let me confess that I’m an "early adopter" happy to be in the second wave of people trying something new. I should also con¬fess that I’m not a computer wonk. I don’t read manuals and don’t explore software to discover all the things it can do for me. My stan¬dard M.O. is to learn a few tools that make my life better – and stop. With me, the hidden potential of programs tends to stay hidden. That said, I love working with Partners’ electronic medical records software, called the longitudinal medical record (LMR). Practicing at Brigham and Women’s Hospital, I have been caring for patients using the LMR on an inpatient and outpatient basis for several years. With each passing year, more of my colleagues also are using the LMR. These days, physicians who do not use the LMR are the outliers, not the ones who do. As with everything in life, though, there are things to complain about: occasional computer freeze-ups; frames that drift off the screen and cannot be "pulled" back; the difficulty in writing pre¬scriptions for non-pharmaceuticals. But there is a lot to like. Love, even. Here is my personal "Top Ten" list:
1 Any time, any place. I can get access to everything on my patients from home or anywhere else. In the evening, I can check laboratory tests drawn that day while watching the Sox on TV.
2 Records are never lost. No one pulls records for me when I see patients, and I never have a problem find¬ing my patients’ charts. And it is all there – inpatient and outpatient.
3 Cut and paste. Partners may not be completely integrated as a health care system, but I do have integrated software on my computer. I can cut and paste text into and out of the LMR from Microsoft Word, and I can cut and paste laboratory data into emails and letters.
4 MGH and BWH information together. When I check my laboratory data and radiology reports, the results from MGH and BWH are presented together in chronological order. The prospect of having information from throughout Partners, inte¬grated and on-line, seems within reach.
5 Go with the flow. Flow sheets let me track patients’ weight, blood pressure, laboratory results, and other data easily over time.
6 Consultants on line. Now that the vast majority of specialists I use are on the LMR, I don’t need to write referral let¬ters or wait for letters from specialists. They look in the LMR at my last note, and I look in the LMR at theirs. We’re all using the same chart.
7 Patient appointments. I can look up all of a patient’s upcoming appointments with other physicians within the system, and often schedule patient visits with me around these other appointments.
8 No need to re-live history. The “Medications” section not only tells me when I started drugs, but it also shows me the medications I have stopped in the past. I then can just go to the note of that date to figure out why I gave up on an agent – reducing the need to re-live mistakes from the past.
9 Faster prescribing. The LMR’s phar¬macy module helps me figure out the likely right dose of various drugs. The pre¬scriptions printed out are legible. Renewing prescriptions just takes a few mouse clicks – my heart doesn’t sink when patients bring in a bag of pill vials and say, “I need new prescriptions for them all.”
10 Better quality. The pharmacy pre¬scribing module prevents me from prescribing drugs to which patients are allergic, or that are likely to interact with other agents a patient already is taking. It even steers me toward cost-effective choic¬es. The health maintenance module tells me when patients are due for mammograms, PAP smears, and other key screening tests. There is a cost in time and productivity for most doctors when they start using the LMR, and not everyone will feel that the ability to function like you are in your office all day long is a clear-cut plus. On the other hand, there’s no question that the LMR improves care. As the LMR becomes more widely used out in the community, PCHI will begin to realize its real potential as an integrated delivery system.