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My recent post on the subject of emails from patients raised more eyebrows than I expected.  It also put me in a position I am unfamiliar with: looking like a luddite.  Perhaps I am not forward-thinking enough in my reluctance to embrace this advance.  Perhaps I have gotten conservative as I grew grey.  Electronic communication is a great idea (I am doing it right now), so why not apply it to my medical practice?  Has Ned Lud gotten into my circle of influence?

This is, of course, extremely ironic.  I lived so much on the cutting edge that my butt developed calluses.  The calluses, however, were not just put there by the edge, they also came from occasional kicking.  The problem is, I have an addiction: I am addicted to change.  I am constantly looking for new and (perhaps) better ways to do things, then impatiently going after anything new and shiny.  This served us well in the sense that I got us on EMR, got it working well, and have continued to keep us away from repeating mistakes too often.  If something doesn't work, I am quick to look for the cause, and more importantly, how to fix it.

I had all sorts of good ideas, often many at one time.  But this caused problems.  First, the ideas were sometimes stupid.  Stupid ideas don't always look dumb before they are tried.  Often changes had unintended consequences which made things harder instead of easier.  The other problem was that too many changes at once causes change burn-out.  People get tired of change, even if the changes are just little tweaks to the system.  After a while I realized that I was actually the cause of many of the exasperated expressions I saw in the office.  I understood the following: a good idea at the wrong time is a bad idea. This has become a mantra for me in the office which has allowed me to sit on my hands when I felt the urge to change.

A good example of this is the tablet PC.  Microsoft had the idea 10 years ago, coming out with an operating system built around a touch interface.  Did it catch on?  Not really.  Why not?  Not because it didn't work - I used these tablets and they did just fine - but because they didn't fix an important enough problem.  So are tablet PC's a bad idea?  Not anymore; ask apple (and the 20 gazillion apple disciples who stood in lines for iPads).

So what about email consults?  Why not take email from patients when it would suffice as an alternative to coming in to the office?  It would save us hassle (I don't want to see people for unnecessary stuff), would potentially make money (some insurance does pay for it), and make patients happy.  Sounds great.  I want to do it.

But a good idea at the wrong time is a bad idea. We are already emailing labs, allowing patients to request appointments and refills electronically, and getting ready to make some of the medical record available 24/7 online for all of our patients.  We are also in the process of complying with "meaningful use."  We are upgrading our system to a newer version.  Our plate is full.

But even more importantly, we need to continue offering care.  We have to keep this plane flying while we rebuild it.  People are getting sick and wanting care while we attempt to change.  Implementing e-visits is a huge task - very disruptive of our current processes.  In the long run this should be a good thing, but one of the main reasons we have been successful in not only adopting EMR, but also being quite profitable as a private primary care office, is that we approach change very cautiously.  The bigger the change, the more planning is required.  We do change; we just take time to make sure we do it well.

That's not Luddism, it's being careful.

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