In contrast, larger groups tended to have in-house lab and practice management systems that exchanged data with their EMRs, and had the leverage to obtain the cooperation of hospitals and other external data producers for electronic data exchange. Some labs or hospitals refused to set up data exchange less often, the practice failed to make necessary programming changes in its own EMR because vendor or internal IT support was lacking. For example, physicians in nine of the eighteen solo/small-group practices we studied could not view any electronic lab results within their EMR, seventeen could not view hospital data, and nine had EMRs that could not exchange any data with their practice management system. Having parallel electronic and paper-based systems forced physicians to switch between systems, thereby slowing workflow, requiring more time to manually enter data from external systems, and increasing physicians' resistance to EMR use. 'Another barrier to EMR use was the lack of adequate electronic data exchange between the EMR and other clinical data systems (such as lab, radiology, and referral systems). Also, templates that help clinicians enter data in coded rather than free-text form facilitated more advanced computer-based decision support for such tasks as care coordination and chronic disease management.' For example, problem-specific templates (such as a sore throat template) with embedded prompts reminded clinicians to ask about particular symptoms, order particular tests and prescriptions, or perform preventive or disease management activities. More advanced use of documentation templates led to greater opportunities for improving quality of care. Basic use of the EMR improved the legibility and accessibility of progress notes and increased the availability of electronic problem and allergy lists. For night workers the maximum working time was set at eight hours in every 24. on the organisation of road transport working time. amending Directive 2003/88/EC concerning certain aspects of the organisation of working time. The definition of working time that the consultants have used is unclear.

More advanced users typed data into templates (electronic forms) that included physical exam and documentation prompts. The definition of working time remains unchanged.

Basic EMR users had their dictated notes transcribed and imported into the EMR, or they typed their own progress notes into unstructured text boxes. 'Although most clinicians maintained electronic problem and allergy lists, physicians varied greatly in how they documented progress notes.

Worktime rh