Chronic pain management is a cross hybrid between surgery and internal medicine. We medically manage patients with chronic narcotic, non-narcotic analgesics and adjuvants as well as perform surgical procedures. To have a legible, up-to-date and accurate record is of the utmost importance. Laws pertaining to narcotics are extensive and very precise, requiring a system that logs each prescription as well as a scanned copy. Procedure notes can be exhaustive, but must be accurate and precise for medical-legal reasons as well as for evidence-based performance. The ability to access all this information simply and quickly was our first priority as we have 4 offices in different parts of the state with considerable crossover between offices. Lastly, our chart storage was becoming a major expense and we were finding it impossible to find a chart when we wanted it. An electronic medical record (EMR) seemed like the best answer.
We were using a transcription service and most of the doctors in our group wanted to continue to dictate their notes as opposed to interfacing with a computer. This was based purely on time and their inability to type even short sentences with any speed. Most EMRs I investigated required the physician to be quite accomplished in either voice recognition or typing performance. Some EMRs made you follow rigid protocols and templates. Others required your patients to fill out their questionnaires to fit their database. None were written for the pain management physician. When I first used Praxis in 1997, I quickly realized that Praxis could adapt to any practice. For two years, I trialed Praxis by myself and did all my notes without the use of a transcriptionist. It was a great success, but it did require an additional 5-10 minutes per patient to finish my notes before I could go on to the next patient. This small inconvenience was paid back many times with the ability to have clear notes, a simple scheduler, legible and precise prescription writing and archived notes for quick access. As Praxis developed, I was able to scan or download my fluoroscopic images into it, and was able to bring them up with outstanding clarity for review and study; I was also able to scan photographs of my patients' painful limbs for documentation of injuries and treatment progress, and use patient questionnaires to log in outcome measures quickly and easily.
My colleagues were eager to have all these wonderful treasures, but were uncomfortable using a computer interface. They wanted to continue to use a transcriptionist. Once again, Praxis showed itself to be very adaptable. We quit our transcription service and hired our own. The doctors dictated their notes to our transcriptionist who then used the Praxis concept processor.
The concept processor is a thing of genius and is the hallmark of Praxis. As the transcriptionist used Praxis, Praxis became smarter and smarter to the point that she could finish a note within minutes of getting it. The doctor no longer had to dictate the entire note, only the important parts of it, because Praxis remembered the rest from the last time this procedure or diagnosis was used. It worked perfectly.
We see approximately 100 patients a day with 30-50 surgical procedures a day. Our notes used to take 2-3 weeks before they were returned from the dictation service. Now, all notes are sent back to the doctor before the end of the day for their review. This is 300-500 pages of text! This has been accomplished without fail since we implemented Praxis clinic wide in 1999.
With the advent of pay for performance and evidence-based medicine, Praxis responded with the ability to prospectively study your practice and show proof that you achieve the highest standard of care.
Praxis is a very adaptable EMR that I feel certain will answer the needs of any physician’s practice. As the practice of medicine continues to change, Praxis will be there to help the doctor meet these challenges.