While I spend far too much time on THCB arguing with Sydney Smith at Medpundit, her blog remains fascinating. At the moment she’s putting in a EMR into her small office practice. Now she’s not the first physician blogger to use an EMR — Enoch uses Epic at the Palo Alto Medical Foundation and Jacob is an early adopter. But those two are atypical nerds (sorry guys!). Given that she’s more or less typical of the majority of the physicians in the country, in that she’s a heavy Internet user in her personal life but hasn’t used a computer too much in her day to day practice workflow, Syd’s experiences are very important, and you should all follow them.

Thus far she’s finding that using the computer is making her slower than she was and that her staff are having some trouble adjusting to the new workflow patterns. This is a pretty typical experience from what I know about EMR installations at larger clinics. But in a larger clinic these dislocation costs don’t directly affect the physician’s income, whereas in a solo practice either the doctor has to work longer hours (and pay staff for staying longer) or see fewer patients. So they’re one huge reason why solo and small practice docs haven’t put in EMRs.

It will be very interesting to see Sydney’s results as the system she uses becomes more familiar to her and her staff, but there are already some positive results for some of her patients that I’d venture to suggest are improving the care they are receiving overall. And today there’s a study in JAMA which shows that information is likely to be missing from one primary care visit in seven, but that it’s much less likely to be missing if the clinic in question has a full EMR.

Syd is to be commended for both taking this leap and keeping us informed about it — warts and all.