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Trying to get everybody to do everything the same way is proving to be a lot harder than I thought it would.

Well, actually, I thought it was going to be pretty hard.

Within our fancy electronic medical record, it seems like there are always multiple ways to do everything we try to do. And everyone develops their own special techniques, their own special ways of getting things done. Protocols, workarounds, shortcuts, and widgets.

Take follow-up of lab results, for example. Using the functionality of the electronic health record, you can click on the results in your "Results" in-basket, leave a chart note, send a letter to a patient, create a telephone encounter, release them through the patient portal and send a message to the patient.

And more.

One of my patients, no matter how I have tried, insists on walking into the practice 48 hours after her appointment, requesting a printout of her labs, and then sitting in the waiting room and requesting to speak to me about each and every result. "Why are my basophils so low?"

Still, despite all these options for ways to inform, there are those abnormal results we discover that despite the lack of any documentation, someone has actually already spoken to a patient and discussed them with them, yet we have no idea what their plan was.

While clearly the most important thing is that the results are communicated to the patient, in the world we live in, it has always been -- and will probably always be -- "If you didn't write it down, it didn't happen."

But there has to be a way we can make it all happen the same way, so that we don't have to work so hard to figure out what happened.

Streamlining these review processes, creating a set of standards so that we're all doing it the same way, is ideal, but trying to get a bunch of ornery providers who practice medicine and interact with the electronic health record in very different ways is definitely proving to be a challenge.

One of the things that contributes massively to the workload of the staff of our practice and the providers in our practice is prescription refills. When we look back at our incoming calls data, prescription refills remain one of the top players, and they account for an enormous sinkhole of time that our staff spend on the phone, our nurses spend reviewing charts, our providers spend doing busy work clicking buttons, and, if you think about it, our patients also need to do to get the medicines that we think they need, that we have prescribed to them, in an effort to improve their health.

Right now, sitting here with my phone in my hand dictating this column, I could open up a separate app, take a picture of a prescription bottle, and with a few clicks send an order for a medication refill to the pharmacy.

Similarly, I can open a refill encounter in the electronic health record, click on the medication list, highlight a few prescriptions, select a pharmacy, and send them on their way.

Patients at home can enter the patient portal, click next to the medicine of interest, and send a request to the last provider who refilled it.

And pharmacies, when a patients calls or walks into their place of business, can send us an email, a request through the electronic health record, or even a fax, requesting refills of a medicine for our patients.

Luckily, e-prescribing has essentially eliminated the phone call from the office into the pharmacy. A patient may still request that I "call in her prescriptions", but I no longer have to pick up the phone, call the pharmacy, go through a telephone tree, wait on hold, and then speak with the pharmacist to relay details about my prescription and hope that it's transcribed correctly, and the pharmacist doesn't have to deal with my garbled speech on a voicemail either.

One of the partners in our practice, frustrated by the enormous amount of work everyone is putting into this refill process, has decided to try a pilot of his own, and says that no matter how these refill requests come to him, he is going to refer them to the pharmacist, and then ask them to generate an electronic request to our system directly.

He hopes that as his patients get used to this workflow, they will no longer call here. Instead, when his patients are running low, they will know to ask their pharmacist to ping us, and we can respond in kind.

This will eliminate dozens and dozens of phone calls to him every day, and he won't have to check a bunch of different electronic in-baskets and two fax machines to make sure his patients are getting their medicines.

I think that he's going to be met with a lot of resistance because a lot of patients like a particular way of getting their medications, the way they have always been doing it.

And the pharmacists may hate this unless we can make it electronically efficient.

Want a refill? Click. Due for a refill? Click. Medically appropriate? Click. Prescribed by me? Click. Satisfied appropriate filters? Done.

Somehow I suspect we're all still going to get voicemails, emails, patient portal messages, faxes, walk-ins, and getting grabbed in the hallway as we walk from one exam room to the next.

Thinking we can change behavior and get everyone to buy into it and stick with the rules is likely to prove as challenging in this venue as in every other in healthcare.

But we have to keep trying, streamlining the way we do things, hopefully eliminating the excess baggage of dealing with all of these multiple systems, to get us to a place where we can much more easily take care of our patients, and our patients can much more easily get the care they need.

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