CanadianEMR: EMR Comparisons, Ratings, Directory Services and Expert Discussions

Lessons Learned from Successful National EMR Programs

What does it take to set up an run a successful national EMR program? What can we learn from countries that have been able to establish programs with high levels of adoption and use by physicians?

Listen to this podcast interview with two world experts in this area. Professor Denis Protti and Professor Abdul Roudsari from the Department of Health Information Science at the University of Victoria.

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Ontario Plan for Electronic Health Records at Risk - Official Says

Strong statements by Doug Tessier, SVP of development and implementation for the agency responsible for implementing the government’s multibillion-dollar electronic health records (EHR) strategy. He touches on a number of points related to policy by the regulatory colleges, expansion of the program and even changes to the way that physicians are compensated related to 'required use' of EHRs.

Canadian Medical Association Journal: March 2, 2010 :The government must also do more to persuade health regulatory colleges to overhaul policies that impact on EHRs, Tessier argues. “Let’s put our arm around them and gently bring them into the 21st century. ... With the regulations, the legislation and the policy changes that government has to do, that’s not so gentle. That’s on the critical path. If they don’t do it, we’re blocked completely.” Tessier also argues that Ontario’s program to encourage physicians and other health care providers to utilize EHRs must be expanded. Under the program, the government absorbs 70% of costs associated with a physician’s move to EHRs. “But it only goes to 9600 [of 24 600] physicians.” Physicians should be required to use EHRs, including applications such as e-prescribing, and to that end, the government should make the use of EHRs a condition of payment for medical services rendered, Tessier says. Tessier also notes that Auditor General Jim McCarter correctly identified that implementing EHRs in Ontario has been complicated by a decision to build the broad information technology infrastructure before developing applications. As McCarter stated in his report, that situation might have been avoided “had there been an overall strategic plan driving the EHR initiative from the very beginning.”

CMAJ: Ontario’s plan for electronic health records is at risk, official says.

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Certification Program Information - Posted by ONC

Posted by the ONC 20 minutes ago - Certification Programs for Health Information Technology

Certification of Health IT will provide assurance to purchasers and other users that an EHR system, or other relevant technology, offers the necessary technological capability, functionality, and security to help them meet the meaningful use criteria established for a given phase. Providers and patients must also be confident that the electronic health IT products and systems they use are secure, can maintain data confidentially, and can work with other systems to share information. Confidence in health IT systems is an important part of advancing health IT system adoption and allowing for the realization of the benefits of improved patient care. Eligible professionals and eligible hospitals who seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required by statute to use Certified EHR Technology. Once certified, Complete EHRs and EHR Modules would be able to be used by eligible professionals and eligible hospitals, or be combined, to meet the statutory requirement for Certified EHR Technology.

To this end, an NPRM proposing the establishment of certification programs for purposes of testing and certifying health information technology was issued in March 2010 with a request for comments.

The NPRM proposes:

• A temporary certification program to assure the availability of Certified EHR Technology prior to the date on which health care providers seeking the incentive payments would begin to report demonstrable meaningful use of Certified EHR Technology.
• A permanent certification program to replace the temporary certification program.

Read more: HealthIT.hhs.gov: Certification NPRM.

Texas Medical Association EMR Survey Report - Fall 2009

Just published by the Texas Medical Association, this report provides detailed analysis of the results of a web survey that was e-mailed to a random sample of 10,000 Texas physicians with responses received from 370 respondents.

While not totally applicable to the Canadian setting because of variances in terms of how care is provided in the US with advanced requirements for billing and practice management, some of the more interesting sections deal with physician response in terms of what they liked most about their EMR and what they dislike.

To download the full report, click here (.doc format)

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The Importance of Good Design in an EMR

Medical Economics (Feb 5, 2010) reported the story of a Utah-based paediatrician who did everything right in the selection of his clinic EMR, but in the end chose the wrong system. So, what went wrong and what lessons can be learned from the experience of Dr. Joseph Kramer?

Dr. Kramer makes some excellent points:

1. They failed to focus on the Computer/Human Interface and did not listen to their gut regarding the design of the computer screen they would have to look at for hours every day;
2. Select a system designed to have clinicians ask and answer questions. Don't select a system that makes it difficult to construct queries;
3. Clicks matter - when sales folks say it is only a click away, be suspicious;
4. Know in advance what you want to do with your EMR.

Click here to read the full article in Medical Economics

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Standards - The Glue that Binds EMRs Together

The importance of standards as a key foundational building block for EMRs is the topic of this week's podcast. Jennifer Zelmer, standards expert and CEO of the IHTSDO (International Health Terminology Standards Development Organization)in Copenhagen, Denmark is interviewed and provides her insights into the need for widespread adoption of standards if we ever want to have true information exchange capability between EMRs and between EMRs and other systems.

Listen to the Podcast

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Health Canada slammed in eHealth audit - The Globe and Mail

Bad news coverage continues regarding the funding for Canada Health Infoway that has been withheld pending budget decisions by the federal government. 

Big questions remain: Does the money get released? Will it be all or part of the allocated $500 million? What processes will need to be put into place to provide additional oversight? If released, how will the funding be distributed to ensure it actually ends up facilitating adoption of EMRs in physician offices?

The Globe and Mail - January 20, 2010: Health Canada handed out millions of dollars to a national eHealth agency without properly accounting for how the money was spent, a new audit says. The finding raises doubts about Health Canada's own record of accountability even as it conducts due diligence before deciding whether to give Canada Health Infoway Inc. another half-billion dollars. The internal audit examined a $400-million, five-year deal the department signed in 2007 with Infoway, created to ensure all Canadians have an electronic health record by 2016. Infoway received its first cheque, for $38.7-million, in October 2007. But the auditors suggest the deal was so badly crafted that Infoway was not required to provide enough information to Health Canada to ensure the money would be well spent. “The information in support of the initial instalment of the new funding was inadequate to verify the validity and appropriateness of the projected expenditures under the terms of the agreement,” says the newly disclosed audit, completed in May last year.

Health Canada slammed in eHealth audit - The Globe and Mail

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Who you Gonna Call when your EMR Stops Working?

You've purchased your EMR and worked out all of the initial bugs. In fact the practice is really functioning smoothly, staff are happy and you smile when going to work in the morning. And then the dreaded unexpected happens. Your EMR slows down, it locks up at times and requires machines to be rebooted, your staff begin to get behind on scanning and in very short order, your blissful existence is threatened. So what do you do?

The likely first step is to call your EMR vendor support line and request help. With some luck, they report that a bug was picked up following the most recent product update. The problem has been fixed and in very short order, a technical support person logs into your office remotely, updates your EMR software and within a day you are back to your normal contented self.

However, this is not always the case. There are many reasons for EMR software to stop functioning properly and a large number of these are out of the control of the EMR vendor. What if the EMR vendor checks your office software, tells you that it is functioning properly and advises you to speak to your hardware vendor and network support vendor. Who coordinates that process in a busy medical practice and how can you be sure that the problem is going to be solved effectively?

The larger the number of individual companies or organizations involved in the process of ensuring that your EMR is going to be operating with 99.9 percent uptime and efficiency, the more complex the support process becomes.

Let's examine how many points of failure there could potentially be in a medical practice. For example a 5 physician practice with 7 support staff, 20 computer workstations, scanners, printers, wired and wireless office network (for the few staff that need mobile access) and an EMR that is ASP based (the EMR is accessed through a secure network, but the data in the EMR is hosted outside of the office in a secure data centre). The following represents a list of potential points of failure:

• The office network of computers - supported by a network consultant (Vendor #1)
• The hardware - supplied by a local hardware company (Vendor #2)
• The secure network - supplied by a provincial service provider (Vendor #3)
• The EMR software - supplied by the software vendor (Vendor #4)
• Suppliers of external information (Lab data, Diagnostic reports, other communications) (Vendors #5+)

A problem with any one of these systems is that if one fails or has a problem, it can have a direct impact on some or all of the others. There is a tendency to blame the EMR vendor when a problem develops, however any of the other systems could be equally responsible.

In countries such as the US, this is further complicated by the fact that a practice could have different EMR and practice management software (adding another vendor to the mix) and if the new system proposed in the US moves forward, a physician may be able to 'assemble' their EMR from a wide range of vendors until they meet all of the requirements for meaningful use of the EMR and thus qualify for funding. (I have no idea how this will take place given the complexities of even managing a single integrated EMR).

All the above being said, it is no wonder that support is challenging for all parties. Physicians and EMR vendors alike.

In order to reduce the risk and make support easier, the rule of thumb should be to reduce the number of variables that have the potential to be a point of failure for your EMR. If you can purchase your hardware and software through your EMR vendor and they are willing and able to provide a single point of contact to call for support of the network, hardware, software - that is a good decision. Even if more expensive in the short-run, it could save plenty of heartache (with concomitant coronary artery disease) in the long run.

Wherever possible aim to have a single organization or individual who is responsible for ensuring your EMR operates properly. In small practices, this is imperative. In larger practices (that can afford a dedicated network and hardware support person) this may not be as much of a priority.

Even a small number of EMR problems can be a significant financial drain on your practice if the issues are not resolved and productivity is reduced for extended periods. Not to mention the personal toll on your colleagues and staff and the impact on patient care if the tools you use on a daily basis just don't work!

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CMAJ: Canada's Electronic Health Records Initiative Stalled!

In the first of an article series on Electronic Health Records published in the CMAJ, the current status of Canadian EHR and EMR strategies is reviewed:

The federal government’s failure to release $500 million in promised funding has slowed the next phase of the multibillion-dollar national effort to implement electronic health records (EHRs), says Canada Health Infoway President Richard Alvarez. The year-long freeze on federal funding has compromised plans to rollout initiatives designed to improve physician uptake of electronic records, Alvarez says. This will do nothing to improve Canada’s status as an international EHR laggard, Alvarez says. “The next very serious phase is basically in community physicians’ offices,” says Alvarez, head of the federal agency created in 2001 to promote provincial and territorial EHR programs. “The vast majority of the [new] money was earmarked for that. That’s an absolutely crucial step in this journey. We’ve been slowed down. If we don’t have money to invest in that area we obviously can’t do that until such time as the money is reinstated.”

Read the full article: CMAJ: Canada's electronic health records initiative stalled by federal funding freeze

While I agree with many of the comments and conclusions in this article, it is imperative that the evolution in Canada's EHR/EMR strategy is supported by strong and insightful clinical leadership, a focus on messaging exchange capability for EMRs and the ability to easily prescribe medications electronically using the EMR.

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The Barrier to Adoption of EMR is not a Shortage of Technology

Pervasive computing is not as distant as you may think. 30+ years ago NASA astronaut's vital signs were already being monitored using telehealth technologies. Many technologies are advanced well beyond the ability to apply them to current problems.

One of the challenges for physicians is the integration of computers into the clinical encounter. Many physicians become quite adept at using a keyboard, templates, short-cuts, speech recognition and achieve high levels of efficiency using an EMR. However, for many it remains a challenge.

What if the technology were all around you? Using speech, gestures, images and commands it was possible to input, photograph and recall patient information seamlessly? Sound a bit futuristic, watch this video from the 2009 TED conference on sixth sense technology. I can see many applications in healthcare.

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Protecting the Security of Patient Data

Security and Privacy are often treated as one and the same, however they are very different. Whereas privacy refers to policies, user identification, access controls and systems design, security refers to firewalls, password management, physical protection of the data etc.

Recently, the health records of 83,000 individuals were lost in Ontario as a result of the loss of a USB key. A micro-SD card smaller than one's thumbnail can store 4GB of information and as solid state hard drives become more popular, we are sure to see the storage capacity of these devices surge. Huge amounts of personal information can be stored on tiny media that are easy to lose or misplace.

Bottom line - make sure that you are extremely careful where and how you store personal patient information. Thinking this through beforehand can avoid dangerous and costly errors at a later date. This is a good lesson for anyone who works with digital patient information.

Health records of 83,000 lost in Ontario OSHAWA, Ont. – Ontario’s privacy commissioner has launched an investigation after a USB drive containing the personal health information of more than 83,000 people, who went to flu clinics in Durham Region just northeast of Toronto, went missing. The USB key contained the personal information of persons who attended a Durham Region Health Department flu vaccination clinic for either an H1N1 or seasonal flu shot between Oct. 23 and Dec. 15. Commission spokesman Bob Spence said the probe will try to determine what happened and what steps might be taken to prevent a similar incident from occurring. A health department nurse was taking a USB key containing the records to her car in Whitby, Ont., for use at a remote clinic site on Dec. 15 when the device was lost. A search failed to turn it up. “We believe it was lost on regional property. We have some video surveillance tape to indicate that was the case,” said Dr. Robert Kyle, chief medical officer of health for Durham Region. Read full article: Canadian Healthcare Technology

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US - Nearly $1 Billion Recovery Act Investment Announced

A significant financial commitment was announced today in the US to support adoption and meaningful use of health IT and EMRs. Click on the link to see how the funding has been allocated.

WASHINGTON, DC - Health and Human Services Secretary Kathleen Sebelius and Labor Secretary Hilda Solis today announced a total of nearly $1 billion in Recovery Act awards to help health care providers advance the adoption and meaningful use of health information technology (IT) and train workers for the health care jobs of the future. The awards will help make health IT available to over 100,000 hospitals and primary care physicians by 2014 and train thousands of people for careers in health care and information technology. This Recovery Act investment will help grow the emerging health IT industry which is expected to support tens of thousands of jobs ranging from nurses and pharmacy techs to IT technicians and trainers.

Click on the link for mor details and to see how the funding has been allocated

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As Health Information goes Digital, Patients may Spot Unpleasant Surprises

A recent article in the Huffington Post pointed out an important issue regarding digital health records.

When Kaiser Permanente started giving patients online access to their medical records nearly five years ago, it offered the same lab reports doctors saw—complete with warning flags highlighting any abnormal results. The capital letters – such as “H” for “high” -- alarmed many patients. So now the giant health plan has modified the policy for most of its members. It displays lab results in a more neutral way, showing patients how they compare to normal ranges and advising them to contact their health practitioner with any questions. The experience at Kaiser reflects the sensitivities that can arise over how much medical data patients should be entitled to view and how quickly—a debate that’s intensifying as medicine enters the digital era.

As Health Files Go Digital, Patients May Spot Unpleasant Surprises

One of the fears of physicians is that providing their patients with access to online health information may increase workload because of examples as described above? It is easy to become alarmed by information that is not well explained.

Do you think this is a legitimate concern? How can these types of issues be addressed?

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