Christopher Notte

www.ehrpc.cominfo@ehrpc.com

One of the promises of electronic health records is easy and secure access to patient information, with the goal of improving outcomes. The hope is that with greater information portability, no matter where a patient seeks care, his or her records would be available. Even if a patient was unconscious in an emergency department far from home, the ED physician would have immediate access to a list of current medications, allergies, and chronic health issues.

Several ways have been proposed to make information sharing possible. One suggestion is the creation of a nationwide web of health information accessible through the Internet or via the interconnection of existing electronic health networks.

Already, many health care systems have created regional health information organizations, or RHIOs. These link hospitals and private practices in a given area together and facilitate secure information exchange.

One large RHIO project has been undertaken by New York City. Through the Primary Care Information Project, the city has gathered physicians and practices under one umbrella, and so far it has linked more than 2,100 providers. In addition, patients can access and update their personal records through an online portal, and can communicate with their physicians through e-mail.

Google and Microsoft already have robust systems in place that facilitate online storage and organization of patient data. Google Health (http://health.google.comwww.healthvault.com

Both services are free to patients and already have established “links” to outside vendors and services, such as Quest Diagnostics and CVS Pharmacy, among many others. This allows information to be updated continuously, as labs are drawn or prescriptions are filled. Both companies promise that they keep the data secure and private, and that they won't disclose any information to inside or outside sources.

The online services seem to be catching on, and several established EHR products allow updated information to be exported automatically to these sites after each patient encounter occurs.

For those wary of storing their personal health data online, some extremists have suggested implantable “chips” that would stay under the skin and could be read only by specialized equipment. More realistically, however, this approach would take the form of a “key fob” or a USB flash drive, which are relatively inexpensive. The critical issue is making sure the information on such devices meets standards that allow it to be accessed in any health care setting. The industry has yet to agree on which standards are to be followed, but a few proposed standards appear to be promising.

One such standard is the Continuity of Care Record, or CCR, developed through a joint partnership among key players, including the Healthcare Information and Management Systems Society (HIMSS), the American Academy of Family Physicians, and the American Academy of Pediatrics.

According to the HIMSS, the CCR is a technology-neutral and vendor-neutral proposed standard for “exchanging basic patient data between one care provider and another to enable this next provider to have ready access to relevant patient information.”

Another proposed standard is the CCD, or Continuity of Care Document. This seeks to unify the CCR with another existing standard known as the HL7 Clinical Document Architecture, or CDA.

Now, if you find yourself confused by all of these acronyms, you are in good company. Even after a thorough investigation into the details of each, it is difficult to determine which, if any, will rise to the top and become the final standard. Even the biggest online health information repositories are in disagreement: Google Health uses the CCR standard, while Microsoft's HealthVault uses a combination of the CCR and the CCD.

Dr. David Blumenthal, the national coordinator for health information technology at the Department of Health and Human Services, has called for the removal of boundaries in health information sharing. “The goal, above all else, is to make care better for patients, and to make it patient-centered” by enabling information to follow the patient, and not allowing technical, business-related, and bureaucratic obstacles to get in the way, he said in a statement.

In other words, regardless of how the information is shared, in the end there is only one standard we need to focus on: the standard of care. Unless we continue to improve this, we'll miss out on the ultimate promise of electronic health records.

www.ehrpc.cominfo@ehrpc.com

One of the promises of electronic health records is easy and secure access to patient information, with the goal of improving outcomes. The hope is that with greater information portability, no matter where a patient seeks care, his or her records would be available. Even if a patient was unconscious in an emergency department far from home, the ED physician would have immediate access to a list of current medications, allergies, and chronic health issues.

Several ways have been proposed to make information sharing possible. One suggestion is the creation of a nationwide web of health information accessible through the Internet or via the interconnection of existing electronic health networks.

Already, many health care systems have created regional health information organizations, or RHIOs. These link hospitals and private practices in a given area together and facilitate secure information exchange.

One large RHIO project has been undertaken by New York City. Through the Primary Care Information Project, the city has gathered physicians and practices under one umbrella, and so far it has linked more than 2,100 providers. In addition, patients can access and update their personal records through an online portal, and can communicate with their physicians through e-mail.

Google and Microsoft already have robust systems in place that facilitate online storage and organization of patient data. Google Health (http://health.google.comwww.healthvault.com

Both services are free to patients and already have established “links” to outside vendors and services, such as Quest Diagnostics and CVS Pharmacy, among many others. This allows information to be updated continuously, as labs are drawn or prescriptions are filled. Both companies promise that they keep the data secure and private, and that they won't disclose any information to inside or outside sources.

The online services seem to be catching on, and several established EHR products allow updated information to be exported automatically to these sites after each patient encounter occurs.

For those wary of storing their personal health data online, some extremists have suggested implantable “chips” that would stay under the skin and could be read only by specialized equipment. More realistically, however, this approach would take the form of a “key fob” or a USB flash drive, which are relatively inexpensive. The critical issue is making sure the information on such devices meets standards that allow it to be accessed in any health care setting. The industry has yet to agree on which standards are to be followed, but a few proposed standards appear to be promising.

One such standard is the Continuity of Care Record, or CCR, developed through a joint partnership among key players, including the Healthcare Information and Management Systems Society (HIMSS), the American Academy of Family Physicians, and the American Academy of Pediatrics.

According to the HIMSS, the CCR is a technology-neutral and vendor-neutral proposed standard for “exchanging basic patient data between one care provider and another to enable this next provider to have ready access to relevant patient information.”

Another proposed standard is the CCD, or Continuity of Care Document. This seeks to unify the CCR with another existing standard known as the HL7 Clinical Document Architecture, or CDA.

Now, if you find yourself confused by all of these acronyms, you are in good company. Even after a thorough investigation into the details of each, it is difficult to determine which, if any, will rise to the top and become the final standard. Even the biggest online health information repositories are in disagreement: Google Health uses the CCR standard, while Microsoft's HealthVault uses a combination of the CCR and the CCD.

Dr. David Blumenthal, the national coordinator for health information technology at the Department of Health and Human Services, has called for the removal of boundaries in health information sharing. “The goal, above all else, is to make care better for patients, and to make it patient-centered” by enabling information to follow the patient, and not allowing technical, business-related, and bureaucratic obstacles to get in the way, he said in a statement.

In other words, regardless of how the information is shared, in the end there is only one standard we need to focus on: the standard of care. Unless we continue to improve this, we'll miss out on the ultimate promise of electronic health records.

www.ehrpc.cominfo@ehrpc.com

One of the promises of electronic health records is easy and secure access to patient information, with the goal of improving outcomes. The hope is that with greater information portability, no matter where a patient seeks care, his or her records would be available. Even if a patient was unconscious in an emergency department far from home, the ED physician would have immediate access to a list of current medications, allergies, and chronic health issues.

Several ways have been proposed to make information sharing possible. One suggestion is the creation of a nationwide web of health information accessible through the Internet or via the interconnection of existing electronic health networks.

Already, many health care systems have created regional health information organizations, or RHIOs. These link hospitals and private practices in a given area together and facilitate secure information exchange.

One large RHIO project has been undertaken by New York City. Through the Primary Care Information Project, the city has gathered physicians and practices under one umbrella, and so far it has linked more than 2,100 providers. In addition, patients can access and update their personal records through an online portal, and can communicate with their physicians through e-mail.

Google and Microsoft already have robust systems in place that facilitate online storage and organization of patient data. Google Health (http://health.google.comwww.healthvault.com

Both services are free to patients and already have established “links” to outside vendors and services, such as Quest Diagnostics and CVS Pharmacy, among many others. This allows information to be updated continuously, as labs are drawn or prescriptions are filled. Both companies promise that they keep the data secure and private, and that they won't disclose any information to inside or outside sources.

The online services seem to be catching on, and several established EHR products allow updated information to be exported automatically to these sites after each patient encounter occurs.

For those wary of storing their personal health data online, some extremists have suggested implantable “chips” that would stay under the skin and could be read only by specialized equipment. More realistically, however, this approach would take the form of a “key fob” or a USB flash drive, which are relatively inexpensive. The critical issue is making sure the information on such devices meets standards that allow it to be accessed in any health care setting. The industry has yet to agree on which standards are to be followed, but a few proposed standards appear to be promising.

One such standard is the Continuity of Care Record, or CCR, developed through a joint partnership among key players, including the Healthcare Information and Management Systems Society (HIMSS), the American Academy of Family Physicians, and the American Academy of Pediatrics.

According to the HIMSS, the CCR is a technology-neutral and vendor-neutral proposed standard for “exchanging basic patient data between one care provider and another to enable this next provider to have ready access to relevant patient information.”

Another proposed standard is the CCD, or Continuity of Care Document. This seeks to unify the CCR with another existing standard known as the HL7 Clinical Document Architecture, or CDA.

Now, if you find yourself confused by all of these acronyms, you are in good company. Even after a thorough investigation into the details of each, it is difficult to determine which, if any, will rise to the top and become the final standard. Even the biggest online health information repositories are in disagreement: Google Health uses the CCR standard, while Microsoft's HealthVault uses a combination of the CCR and the CCD.

Dr. David Blumenthal, the national coordinator for health information technology at the Department of Health and Human Services, has called for the removal of boundaries in health information sharing. “The goal, above all else, is to make care better for patients, and to make it patient-centered” by enabling information to follow the patient, and not allowing technical, business-related, and bureaucratic obstacles to get in the way, he said in a statement.

In other words, regardless of how the information is shared, in the end there is only one standard we need to focus on: the standard of care. Unless we continue to improve this, we'll miss out on the ultimate promise of electronic health records.

www.ehrpc.cominfo@ehrpc.com

When considering the transition to an EHR system, it is essential to think about more than just the software. The hardware can be just as important. All EHR vendors have minimum specifications required to ensure the proper functioning of their system, but most will allow individual practices to use existing computers or purchase new equipment on their own. When companies do suggest specific hardware, they often choose costly equipment that far exceeds the basic system requirements. Since this may not make sense for your practice and can far exceed your budget, it can be very helpful to think through the process ahead of time and truly assess your needs to maximize productivity and minimize price. Here are some issues to consider:

▸ To PC or not to PC?

Regardless of your personal preference, the majority of EHRs run under the Windows operating system. If your office is already outfitted with Macs, you might need to replace them. You could also install Windows using software such as Boot Camp, a program that ships with new Intel-based Macs.

If your office is already established on PCs, you must determine if they meet the EHR's minimum specs. It won't take long to realize that running the software on a slow computer is frustrating, so consider the amount of RAM and processor speed in each unit.

Either way, be sure to find out exactly which version of Windows the software requires, as changing the operating system can be a very costly and time-consuming experience. For example, one well-known EHR product requires Windows XP Professional. XP Home Edition and other versions of Windows simply will not work. And, not surprisingly, many EHRs don't play well with Windows Vista.

▸ Desktop, notebook, or tablet PC?

Initially, a lot of physicians wonder how an EHR will affect their documentation. Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. It is therefore very helpful to put some forethought into how you'll best be able to integrate computers into the office visit.

Some practices choose to install desktop computers in each exam room. In general, desktops are cheaper and more comfortable to navigate. On the downside, they cannot be easily moved to optimize patient interactions and take up a significant amount of space in the room. They also require power and network wiring.

As an alternative, consider wireless notebooks. They are mobile, flexible, and take up much less space, but they are typically more costly to purchase, can be quite heavy, and might be dropped and easily damaged. They may also have a small keyboard and a less-than-convenient pointing device.

For this reason, tablet PCs have become very popular in medicine. A tablet PC may or may not have a keyboard, but all are designed around a touch screen on which a digital pen serves as the mouse. While seemingly wonderful in concept, learning to use the pen to enter complicated information has a steep learning curve and can be extremely frustrating. Many EHR products address this issue by developing schemes to expedite the documentation process. Some involve a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.

In the end, regardless of the type of PC you choose, expect it to take some time to get used to the new process of documentation. You may initially find yourself in the exam room with your face buried in the computer screen. Some get around this by documenting after they leave the room, a process that can become a significant time drain. Others choose to employ dictation software that allows them to speak directly into the EHR to generate a note. Although these programs are constantly improving, they still require training and may take a good deal of time to use accurately. No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. Moving forward, the initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes and charts that are never lost.

▸ Durability, price, and options.

Inevitably, every practice will need to purchase new computers. When making this decision, consider longevity as well as price. Extended warranties and service plans may be a high priority, but given the ever-dropping costs of computer hardware, some may decline to spend the money up front and risk the cost of replacement. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be attractively priced, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs. You will find that batteries die at the worst possible times, and it is convenient to have another battery freshly charged and ready to go.

www.ehrpc.cominfo@ehrpc.com

When considering the transition to an EHR system, it is essential to think about more than just the software. The hardware can be just as important. All EHR vendors have minimum specifications required to ensure the proper functioning of their system, but most will allow individual practices to use existing computers or purchase new equipment on their own. When companies do suggest specific hardware, they often choose costly equipment that far exceeds the basic system requirements. Since this may not make sense for your practice and can far exceed your budget, it can be very helpful to think through the process ahead of time and truly assess your needs to maximize productivity and minimize price. Here are some issues to consider:

▸ To PC or not to PC?

Regardless of your personal preference, the majority of EHRs run under the Windows operating system. If your office is already outfitted with Macs, you might need to replace them. You could also install Windows using software such as Boot Camp, a program that ships with new Intel-based Macs.

If your office is already established on PCs, you must determine if they meet the EHR's minimum specs. It won't take long to realize that running the software on a slow computer is frustrating, so consider the amount of RAM and processor speed in each unit.

Either way, be sure to find out exactly which version of Windows the software requires, as changing the operating system can be a very costly and time-consuming experience. For example, one well-known EHR product requires Windows XP Professional. XP Home Edition and other versions of Windows simply will not work. And, not surprisingly, many EHRs don't play well with Windows Vista.

▸ Desktop, notebook, or tablet PC?

Initially, a lot of physicians wonder how an EHR will affect their documentation. Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. It is therefore very helpful to put some forethought into how you'll best be able to integrate computers into the office visit.

Some practices choose to install desktop computers in each exam room. In general, desktops are cheaper and more comfortable to navigate. On the downside, they cannot be easily moved to optimize patient interactions and take up a significant amount of space in the room. They also require power and network wiring.

As an alternative, consider wireless notebooks. They are mobile, flexible, and take up much less space, but they are typically more costly to purchase, can be quite heavy, and might be dropped and easily damaged. They may also have a small keyboard and a less-than-convenient pointing device.

For this reason, tablet PCs have become very popular in medicine. A tablet PC may or may not have a keyboard, but all are designed around a touch screen on which a digital pen serves as the mouse. While seemingly wonderful in concept, learning to use the pen to enter complicated information has a steep learning curve and can be extremely frustrating. Many EHR products address this issue by developing schemes to expedite the documentation process. Some involve a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.

In the end, regardless of the type of PC you choose, expect it to take some time to get used to the new process of documentation. You may initially find yourself in the exam room with your face buried in the computer screen. Some get around this by documenting after they leave the room, a process that can become a significant time drain. Others choose to employ dictation software that allows them to speak directly into the EHR to generate a note. Although these programs are constantly improving, they still require training and may take a good deal of time to use accurately. No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. Moving forward, the initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes and charts that are never lost.

▸ Durability, price, and options.

Inevitably, every practice will need to purchase new computers. When making this decision, consider longevity as well as price. Extended warranties and service plans may be a high priority, but given the ever-dropping costs of computer hardware, some may decline to spend the money up front and risk the cost of replacement. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be attractively priced, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs. You will find that batteries die at the worst possible times, and it is convenient to have another battery freshly charged and ready to go.

www.ehrpc.cominfo@ehrpc.com

When considering the transition to an EHR system, it is essential to think about more than just the software. The hardware can be just as important. All EHR vendors have minimum specifications required to ensure the proper functioning of their system, but most will allow individual practices to use existing computers or purchase new equipment on their own. When companies do suggest specific hardware, they often choose costly equipment that far exceeds the basic system requirements. Since this may not make sense for your practice and can far exceed your budget, it can be very helpful to think through the process ahead of time and truly assess your needs to maximize productivity and minimize price. Here are some issues to consider:

▸ To PC or not to PC?

Regardless of your personal preference, the majority of EHRs run under the Windows operating system. If your office is already outfitted with Macs, you might need to replace them. You could also install Windows using software such as Boot Camp, a program that ships with new Intel-based Macs.

If your office is already established on PCs, you must determine if they meet the EHR's minimum specs. It won't take long to realize that running the software on a slow computer is frustrating, so consider the amount of RAM and processor speed in each unit.

Either way, be sure to find out exactly which version of Windows the software requires, as changing the operating system can be a very costly and time-consuming experience. For example, one well-known EHR product requires Windows XP Professional. XP Home Edition and other versions of Windows simply will not work. And, not surprisingly, many EHRs don't play well with Windows Vista.

▸ Desktop, notebook, or tablet PC?

Initially, a lot of physicians wonder how an EHR will affect their documentation. Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. It is therefore very helpful to put some forethought into how you'll best be able to integrate computers into the office visit.

Some practices choose to install desktop computers in each exam room. In general, desktops are cheaper and more comfortable to navigate. On the downside, they cannot be easily moved to optimize patient interactions and take up a significant amount of space in the room. They also require power and network wiring.

As an alternative, consider wireless notebooks. They are mobile, flexible, and take up much less space, but they are typically more costly to purchase, can be quite heavy, and might be dropped and easily damaged. They may also have a small keyboard and a less-than-convenient pointing device.

For this reason, tablet PCs have become very popular in medicine. A tablet PC may or may not have a keyboard, but all are designed around a touch screen on which a digital pen serves as the mouse. While seemingly wonderful in concept, learning to use the pen to enter complicated information has a steep learning curve and can be extremely frustrating. Many EHR products address this issue by developing schemes to expedite the documentation process. Some involve a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.

In the end, regardless of the type of PC you choose, expect it to take some time to get used to the new process of documentation. You may initially find yourself in the exam room with your face buried in the computer screen. Some get around this by documenting after they leave the room, a process that can become a significant time drain. Others choose to employ dictation software that allows them to speak directly into the EHR to generate a note. Although these programs are constantly improving, they still require training and may take a good deal of time to use accurately. No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. Moving forward, the initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes and charts that are never lost.

▸ Durability, price, and options.

Inevitably, every practice will need to purchase new computers. When making this decision, consider longevity as well as price. Extended warranties and service plans may be a high priority, but given the ever-dropping costs of computer hardware, some may decline to spend the money up front and risk the cost of replacement. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be attractively priced, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs. You will find that batteries die at the worst possible times, and it is convenient to have another battery freshly charged and ready to go.

www.ehrpc.com

When considering the transition to an EHR system, think about hardware, which can be just as important as software. Here are some issues to consider as you assess your needs:

▸ To PC or not to PC? Most EHRs run under Windows. If your office is already outfitted with Macs, you might need to replace them or install Windows using a program for Intel-based Macs. If your office is already established on PCs, you must determine if your office computers meet the EHR's minimum specs. Find out exactly which Windows version the software requires, as changing the operating system can be a costly and time-consuming experience.

▸ Desktop, notebook, or tablet PC? Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. Desktops are cheaper and more comfortable to navigate. But they take up a lot of space in the exam room and cannot be easily moved. Wireless notebooks are mobile, flexible, and smaller, but they can be heavy, more costly to purchase, and fragile. A tablet PC is designed around a touch screen on which a digital pen serves as the mouse. Learning to use the pen to enter complicated information can be frustrating, but many EHR products have a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.

No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. The initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes, and charts that are never lost.

▸ Durability, price, and other options. Consider longevity as well as price when you purchase computers. Given the ever-dropping costs of hardware, extended warranties may not be useful. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be inexpensive, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs.

www.ehrpc.com

When considering the transition to an EHR system, think about hardware, which can be just as important as software. Here are some issues to consider as you assess your needs:

▸ To PC or not to PC? Most EHRs run under Windows. If your office is already outfitted with Macs, you might need to replace them or install Windows using a program for Intel-based Macs. If your office is already established on PCs, you must determine if your office computers meet the EHR's minimum specs. Find out exactly which Windows version the software requires, as changing the operating system can be a costly and time-consuming experience.

▸ Desktop, notebook, or tablet PC? Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. Desktops are cheaper and more comfortable to navigate. But they take up a lot of space in the exam room and cannot be easily moved. Wireless notebooks are mobile, flexible, and smaller, but they can be heavy, more costly to purchase, and fragile. A tablet PC is designed around a touch screen on which a digital pen serves as the mouse. Learning to use the pen to enter complicated information can be frustrating, but many EHR products have a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.

No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. The initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes, and charts that are never lost.

▸ Durability, price, and other options. Consider longevity as well as price when you purchase computers. Given the ever-dropping costs of hardware, extended warranties may not be useful. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be inexpensive, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs.

www.ehrpc.com

When considering the transition to an EHR system, think about hardware, which can be just as important as software. Here are some issues to consider as you assess your needs:

▸ To PC or not to PC? Most EHRs run under Windows. If your office is already outfitted with Macs, you might need to replace them or install Windows using a program for Intel-based Macs. If your office is already established on PCs, you must determine if your office computers meet the EHR's minimum specs. Find out exactly which Windows version the software requires, as changing the operating system can be a costly and time-consuming experience.

▸ Desktop, notebook, or tablet PC? Whether you currently dictate or handwrite your notes, installing an electronic system can dramatically change the way you practice. Desktops are cheaper and more comfortable to navigate. But they take up a lot of space in the exam room and cannot be easily moved. Wireless notebooks are mobile, flexible, and smaller, but they can be heavy, more costly to purchase, and fragile. A tablet PC is designed around a touch screen on which a digital pen serves as the mouse. Learning to use the pen to enter complicated information can be frustrating, but many EHR products have a series of pull-down menus and check-offs, allowing the provider to quickly click through the available options and only “write” the rare additional information not already covered by the forms.

No matter how you enter the information, practice makes perfect, and you'll find that documenting as you go becomes more efficient with time. The initial drawbacks of computerized documentation are quickly replaced with the advantages of legible, indexed notes, and charts that are never lost.

▸ Durability, price, and other options. Consider longevity as well as price when you purchase computers. Given the ever-dropping costs of hardware, extended warranties may not be useful. Also, consider purchasing refurbished models. Major vendors such as Dell, HP, and Lenovo offer refurbished PCs for a fraction of the cost of new models. Often, these come with the same warranty and return policy. Be cautious about purchasing computers at retail or warehouse stores. These models may be inexpensive, but they are typically geared for home use and may not come with the proper version of Windows. Finally, inquire about getting additional batteries and an external battery charger if you opt for portable PCs.

Guidelines are most useful when they are available to answer questions at the point of care. A concise yet complete handheld computer version of this guideline is available for download, compliments of FAMILY PRACTICE NEWS, at www.redi-reference.com

Many studies suggest that premature ejaculation is the most common male sexual disorder, and according to the National Health and Social Life Survey, the prevalence of premature ejaculation in the United States is 21% in men aged 18–59. Although there is no universally accepted definition of premature ejaculation, the American Urological Association (AUA), defines it as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.”

Clinical Evaluation

The AUA emphasizes that “the diagnosis of premature ejaculation (PE) is based on sexual history alone.” As a result, a detailed history should be obtained from all patients with ejaculatory complaints, with particular attention paid to time to ejaculation. Additional relevant details include frequency and pattern of PE, relationship to specific partners, degree of stimulus resulting in ejaculation, nature and frequency of sexual activity (including masturbation and intercourse), relationship to drug use or abuse, and psychosocial impact of PE. It is valuable to obtain input from sexual partners as well.

It's also imperative to distinguish PE from erectile dysfunction (ED), the inability to sustain a sufficient erection prior to ejaculation, though the conditions often coexist. In patients with concomitant PE and ED, the erectile dysfunction should be treated first, and PE may improve if the ED is effectively treated. It is not necessary to perform laboratory or physiologic testing unless history and physical exam reveal specific indications for doing so.

Recommendations for Treatment

The AUA makes it clear that “patient and partner satisfaction is the primary target outcome for the treatment of PE.” Because PE is not life-threatening, the safety of a treatment should be the most important concern. Certain treatments, such as neurectomy and prosthetic implants, have risks that far outweigh their benefits. It is also important to note that no pharmacologic treatments have FDA-approved indications for PE, but the following agents have been studied:

▸ Serotonin reuptake inhibitors. In clinical trials, SRIs have proven to be more effective than placebo in treating PE. SRI options include fluoxetine, paroxetine, and sertraline (selective SRIs), as well as clomipramine (a nonselective SRI). Many dosages and dosing regimens have been evaluated, and it is unclear whether continuous daily dosing or situational dosing is superior for managing all patients. It is therefore recommended that dosage regimens be based on patient needs, compliance concerns, and frequency of sexual activity. Doses of SRIs used in treating PE tend to be lower than those recommended in the treatment of depression, and duration of therapy has not been established. SRI use will most likely be needed on a continuing basis; experience has shown that PE returns when treatment with SRIs is terminated. Adverse effects from SRI use for PE are similar to those seen in treating depression and are considered acceptable for the benefits seen in patients with PE.

▸ Topical anesthetic agents. According to the AUA, topical anesthetic agents may be applied to the penis prior to intercourse to delay ejaculation. Approximately 2.5 g of lidocaine/prilocaine cream applied 20–30 minutes before intercourse has been shown to increase latency time without significant side effects. It is important to note that topical agents may be used with or without a condom and may be wiped off immediately prior to intercourse to prevent transfer of product to the partner's vaginal wall. One concern when using these products, however, is increased numbness in the penis after prolonged periods of time, leading to loss of erection. This loss in penile sensation may make topical treatment unacceptable to many patients and thereby limit its use.

▸ Other pharmacologic therapies. There have been other agents proposed for the treatment of PE. These involve therapies typically used in the management of erectile dysfunction. There is a small amount of evidence suggesting intracorporal injection of a vasoactive agent, such as alprostadil, or use of sildenafil may increase latency in patients with PE. There is also evidence to suggest that combined use of sildenafil and paroxetine on a situational basis is more effective than paroxetine alone, albeit with an increase in the frequency of headaches and flushing. One other possibility for treatment involves medications that effect adrenergic blockade, as ejaculation is modulated by the sympathetic nervous system. One study using alfuzosin and terazosin showed mild efficacy at increasing ejaculation latency.

The Bottom Line

Premature ejaculation is diagnosed exclusively by patient history, so a detailed sexual history should be obtained from all patients with ejaculatory complaints. Serotonin reuptake inhibitors have become the mainstay of medical treatment, but other possibilities, including topical anesthetics, sildenafil, and adrenergic blockers, have been studied.

DR. SKOLNIK is associate director of the family practice residency program at Abington (Pa.) Memorial Hospital. He is also a coauthor of the “Redi-Reference Clinical Guidelines” handbook for handheld computers. DR. NOTTE is a second-year resident in family medicine at the hospital.

Guidelines are most useful when they are available to answer questions at the point of care. A concise yet complete handheld computer version of this guideline is available for download, compliments of FAMILY PRACTICE NEWS, at www.redi-reference.com

Many studies suggest that premature ejaculation is the most common male sexual disorder, and according to the National Health and Social Life Survey, the prevalence of premature ejaculation in the United States is 21% in men aged 18–59. Although there is no universally accepted definition of premature ejaculation, the American Urological Association (AUA), defines it as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.”

Clinical Evaluation

The AUA emphasizes that “the diagnosis of premature ejaculation (PE) is based on sexual history alone.” As a result, a detailed history should be obtained from all patients with ejaculatory complaints, with particular attention paid to time to ejaculation. Additional relevant details include frequency and pattern of PE, relationship to specific partners, degree of stimulus resulting in ejaculation, nature and frequency of sexual activity (including masturbation and intercourse), relationship to drug use or abuse, and psychosocial impact of PE. It is valuable to obtain input from sexual partners as well.

It's also imperative to distinguish PE from erectile dysfunction (ED), the inability to sustain a sufficient erection prior to ejaculation, though the conditions often coexist. In patients with concomitant PE and ED, the erectile dysfunction should be treated first, and PE may improve if the ED is effectively treated. It is not necessary to perform laboratory or physiologic testing unless history and physical exam reveal specific indications for doing so.

Recommendations for Treatment

The AUA makes it clear that “patient and partner satisfaction is the primary target outcome for the treatment of PE.” Because PE is not life-threatening, the safety of a treatment should be the most important concern. Certain treatments, such as neurectomy and prosthetic implants, have risks that far outweigh their benefits. It is also important to note that no pharmacologic treatments have FDA-approved indications for PE, but the following agents have been studied:

▸ Serotonin reuptake inhibitors. In clinical trials, SRIs have proven to be more effective than placebo in treating PE. SRI options include fluoxetine, paroxetine, and sertraline (selective SRIs), as well as clomipramine (a nonselective SRI). Many dosages and dosing regimens have been evaluated, and it is unclear whether continuous daily dosing or situational dosing is superior for managing all patients. It is therefore recommended that dosage regimens be based on patient needs, compliance concerns, and frequency of sexual activity. Doses of SRIs used in treating PE tend to be lower than those recommended in the treatment of depression, and duration of therapy has not been established. SRI use will most likely be needed on a continuing basis; experience has shown that PE returns when treatment with SRIs is terminated. Adverse effects from SRI use for PE are similar to those seen in treating depression and are considered acceptable for the benefits seen in patients with PE.

▸ Topical anesthetic agents. According to the AUA, topical anesthetic agents may be applied to the penis prior to intercourse to delay ejaculation. Approximately 2.5 g of lidocaine/prilocaine cream applied 20–30 minutes before intercourse has been shown to increase latency time without significant side effects. It is important to note that topical agents may be used with or without a condom and may be wiped off immediately prior to intercourse to prevent transfer of product to the partner's vaginal wall. One concern when using these products, however, is increased numbness in the penis after prolonged periods of time, leading to loss of erection. This loss in penile sensation may make topical treatment unacceptable to many patients and thereby limit its use.

▸ Other pharmacologic therapies. There have been other agents proposed for the treatment of PE. These involve therapies typically used in the management of erectile dysfunction. There is a small amount of evidence suggesting intracorporal injection of a vasoactive agent, such as alprostadil, or use of sildenafil may increase latency in patients with PE. There is also evidence to suggest that combined use of sildenafil and paroxetine on a situational basis is more effective than paroxetine alone, albeit with an increase in the frequency of headaches and flushing. One other possibility for treatment involves medications that effect adrenergic blockade, as ejaculation is modulated by the sympathetic nervous system. One study using alfuzosin and terazosin showed mild efficacy at increasing ejaculation latency.

The Bottom Line

Premature ejaculation is diagnosed exclusively by patient history, so a detailed sexual history should be obtained from all patients with ejaculatory complaints. Serotonin reuptake inhibitors have become the mainstay of medical treatment, but other possibilities, including topical anesthetics, sildenafil, and adrenergic blockers, have been studied.

DR. SKOLNIK is associate director of the family practice residency program at Abington (Pa.) Memorial Hospital. He is also a coauthor of the “Redi-Reference Clinical Guidelines” handbook for handheld computers. DR. NOTTE is a second-year resident in family medicine at the hospital.

Guidelines are most useful when they are available to answer questions at the point of care. A concise yet complete handheld computer version of this guideline is available for download, compliments of FAMILY PRACTICE NEWS, at www.redi-reference.com

Many studies suggest that premature ejaculation is the most common male sexual disorder, and according to the National Health and Social Life Survey, the prevalence of premature ejaculation in the United States is 21% in men aged 18–59. Although there is no universally accepted definition of premature ejaculation, the American Urological Association (AUA), defines it as “ejaculation that occurs sooner than desired, either before or shortly after penetration, causing distress to either one or both partners.”

Clinical Evaluation

The AUA emphasizes that “the diagnosis of premature ejaculation (PE) is based on sexual history alone.” As a result, a detailed history should be obtained from all patients with ejaculatory complaints, with particular attention paid to time to ejaculation. Additional relevant details include frequency and pattern of PE, relationship to specific partners, degree of stimulus resulting in ejaculation, nature and frequency of sexual activity (including masturbation and intercourse), relationship to drug use or abuse, and psychosocial impact of PE. It is valuable to obtain input from sexual partners as well.

It's also imperative to distinguish PE from erectile dysfunction (ED), the inability to sustain a sufficient erection prior to ejaculation, though the conditions often coexist. In patients with concomitant PE and ED, the erectile dysfunction should be treated first, and PE may improve if the ED is effectively treated. It is not necessary to perform laboratory or physiologic testing unless history and physical exam reveal specific indications for doing so.

Recommendations for Treatment

The AUA makes it clear that “patient and partner satisfaction is the primary target outcome for the treatment of PE.” Because PE is not life-threatening, the safety of a treatment should be the most important concern. Certain treatments, such as neurectomy and prosthetic implants, have risks that far outweigh their benefits. It is also important to note that no pharmacologic treatments have FDA-approved indications for PE, but the following agents have been studied:

▸ Serotonin reuptake inhibitors. In clinical trials, SRIs have proven to be more effective than placebo in treating PE. SRI options include fluoxetine, paroxetine, and sertraline (selective SRIs), as well as clomipramine (a nonselective SRI). Many dosages and dosing regimens have been evaluated, and it is unclear whether continuous daily dosing or situational dosing is superior for managing all patients. It is therefore recommended that dosage regimens be based on patient needs, compliance concerns, and frequency of sexual activity. Doses of SRIs used in treating PE tend to be lower than those recommended in the treatment of depression, and duration of therapy has not been established. SRI use will most likely be needed on a continuing basis; experience has shown that PE returns when treatment with SRIs is terminated. Adverse effects from SRI use for PE are similar to those seen in treating depression and are considered acceptable for the benefits seen in patients with PE.

▸ Topical anesthetic agents. According to the AUA, topical anesthetic agents may be applied to the penis prior to intercourse to delay ejaculation. Approximately 2.5 g of lidocaine/prilocaine cream applied 20–30 minutes before intercourse has been shown to increase latency time without significant side effects. It is important to note that topical agents may be used with or without a condom and may be wiped off immediately prior to intercourse to prevent transfer of product to the partner's vaginal wall. One concern when using these products, however, is increased numbness in the penis after prolonged periods of time, leading to loss of erection. This loss in penile sensation may make topical treatment unacceptable to many patients and thereby limit its use.

▸ Other pharmacologic therapies. There have been other agents proposed for the treatment of PE. These involve therapies typically used in the management of erectile dysfunction. There is a small amount of evidence suggesting intracorporal injection of a vasoactive agent, such as alprostadil, or use of sildenafil may increase latency in patients with PE. There is also evidence to suggest that combined use of sildenafil and paroxetine on a situational basis is more effective than paroxetine alone, albeit with an increase in the frequency of headaches and flushing. One other possibility for treatment involves medications that effect adrenergic blockade, as ejaculation is modulated by the sympathetic nervous system. One study using alfuzosin and terazosin showed mild efficacy at increasing ejaculation latency.

The Bottom Line

Premature ejaculation is diagnosed exclusively by patient history, so a detailed sexual history should be obtained from all patients with ejaculatory complaints. Serotonin reuptake inhibitors have become the mainstay of medical treatment, but other possibilities, including topical anesthetics, sildenafil, and adrenergic blockers, have been studied.

DR. SKOLNIK is associate director of the family practice residency program at Abington (Pa.) Memorial Hospital. He is also a coauthor of the “Redi-Reference Clinical Guidelines” handbook for handheld computers. DR. NOTTE is a second-year resident in family medicine at the hospital.