Almost exactly three months ago, Ted and I had the pleasure of visiting Dr. Mike Schierman, a primary care physician in Danville, California, practicing with two other part-time physicians. They are part of the John Muir IPA.

At that time, he had just begun implementing an EHR and many of our initial reactions are in a previous post. Although the sheer volume of work to convert a private practice to fully digital is daunting and remains a challenge, it’s clear that the process is progressing well. Dr. Schierman appeared more comfortable in how he used the computer and the EHR in the exam room.

Perhaps what I found most interesting this time is that his patients are impressed with his EHR use. One patient expressed enthusiasm on her visit to Dr. Schierman since implementation began and noted that her kids’ pediatrician is now using a similar system. None of Dr. Schierman’s patients begrudged him for needing to work with the computer as well as interacting with them—they seem to understand the value of having the EHR, and they

When Dr. Schierman stepped out of the room to get something, one patient—a retired carpenter—queried me about what I did. I vaguely described the PCHIT project and he quickly and excitedly asked me, “Am I going to be able to access my health information online?”

For others, it clearly would be important to do more than just put personal health information like lab data online—it’s not that they wouldn’t want access to it, but just that they would want it to be connected to something that explained it to them. Dr. Schierman asked if one patient if she wanted a copy of her labs. At first, she wasn’t sure because, “I wouldn’t know what they mean if you didn’t go over them with you.” Dr. Schierman printed out the labs and went over them with her thoroughly, categorizing and explaining each set of them, which she clearly appreciated. She then took the printed copy home with her.

Perhaps the most frustrating piece of the EHR implementation has been with the e-prescribing module, which has been shut down for now. A lot of the prescriptions weren’t getting to the pharmacies, which resulted in the doctors’ office being inundated with phone calls from patients. They intend to try again in the summer, when the volume of prescriptions isn’t so high. However, Dr. Schierman continues to use his computer to transmit a fax prescription to each patient’s preferred pharmacy—something that still really impresses his patients.

That provides real value to them because it increases their convenience (“You mean that the prescriptions will be there when I go to pick them up at my regular pharmacy?”). Perhaps more importantly, they get a sense that Dr. Schierman is a progressive doctor—working hard to make his practice as efficient and modern as possible.

Dr. Schierman is mostly pleased with how the transition is going, but he did say, “There are so many moving parts… It’s hard to make sure everything is on track.” Unlike larger practices that may—for example—have a training budget, Dr. Schierman and his office staff have “learn as we go, just testing out things and seeing what works.” But clearly he is well on his way, and his patients are very appreciative of the progress.

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