Cox Family Medicine Residency

Cox Family Medicine Residency is an 8/8/8 program with a rural focus. In 1996, it became the first program in the United States to implement an electronic medical record (EMR) system called Logician (now called Centricity). Because the system was so new, there were many wrinkles for faculty, residents and staff to iron out.

“In 1996 there were a lot of limits to technology that we don’t have today,” said residency faculty member Dorothy Harsen, RNBC, FNP. “Our biggest frustration was with the system being slow. Sometimes we would get hung up for one to two minutes. Today, we get frustrated if there is a five-second delay!”

It was also difficult to trust an electronic system initially, so the program weaned itself from using paper charts gradually. Once the EMR system was in place, the staff put a red dot sticker on each paper chart every time it was pulled. According to Harsen, the goal was to have all of the pertinent historical information entered into the computer by the time a chart was marked with the third red dot.

As the system was fine-tuned and faculty, residents and staff became more computer-savvy, the learning curve improved noticeably. “[At first], we spent all day in training on a test system because it was such a foreign concept to us,” Harsen said. “Now, we orient new residents in three hours on the live system.”

Initially, Cox Family Medicine Residency focused on documenting and storing patient data with their EMR system. However, after a few years, faculty and residents began sorting data on the basis of “observational terms” to generate reports. The program has incorporated decision support tools into its forms. Additionally, said Harsen, “We have access to the Internet from the exam room to be able to look up information from sources such as DynaMed, UpToDate and the [Centers for Disease Control and Prevention] (CDC).”

Among the benefits of the EMR system are the ability to access patient charts from multiple locations, ready access to clinical practice guidelines and electronic prescription refill ordering. Centricity has also proven its value for checking medication interactions. “I don’t know how we survived without this [function],” Harsen said. “The interaction checking is coded red, yellow and green—like a stoplight—for severity of the consequences.”

Cox Family Medicine Residency has also used the EMR system to develop a diabetes registry. A report card that logs essential information about each patient who has diabetes is available to both the care provider and the patient. The improvement in the quality of care has been striking. “Before [we used] provider report cards, it was easy to say, ‘I have my [patients who have diabetes] under good control; [I] make sure they see the eye doctor and monitor their kidney function.’” Harsen said. “But once we could see the numbers in black and white, we realized that sometimes we just thought we were doing that.”

According to Harsen, taking advantage of Centricity’s many features has made a huge impact on Cox Family Medicine Residency’s effectiveness. “The [EMR] has completely changed our culture,” she said.