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

Tablet PCs - Slates vs. Convertible Laptops

The following comment is posted on behalf of Dr. Shelin Tkatch:

I am a solo-practitioner ob/gyn about to embark on EMR in the office. The likely software vendor will be Optimed. I plan to use a tablet pc as my input device and am trying to decide between a “pure slate” device like motion computings LE 1600 which comes equipped with an optional extended battery life of up to 7hr, an integrated eraser in  the digitizer pen, and optional medical word recognition software. One of my main concerns is whether the absence of an integrated keyboard will hamper me and speed of service availability.

The alternative under consideration  is the Toshiba portege M200, which has a keyboard, battery life of 4.5 hrs and since Toshiba is a big seller in Canada it can hopefully be serviced quickly. They both weigh about the same. I plan to use the tablet to write my notes while with the patient, just as I currently do, and then dictate letters as necessary using an  Olympus digital recorder, my pc and dragon speak, again just as I currently do.

Does anyone out there have any experience/advice regarding tablet pcs?

Dr. Shelin Tkatch

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Can e-bookings help reduce surgical backlog?

One of the trends that is taking place in healthcare worldwide is that of providing greater control to patients in order improve system efficiency and improve convenience of services. This is a very interesting program taking place in the UK to allow phyicians to book hospital procedures directly through their EMR systems.

However, as an article in The Guardian points out, this is a huge cultural shift in terms of the way that care is provided. Do you think that we should be moving in this direction in Canada? Obviously this will be an extremely painful process initially as the system is wrenched to deliver services in a different manner. Does the end-result justify the pain?

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"Of all the IT-underpinned transformations in public services being driven by the government, few are as big or controversial as NHS Choose and Book. The idea - at the heart of Tony Blair's NHS reforms - is for patients to be able to choose which hospital their GP refers them to for an operation or tests.

The technology to make this work is the first major implementation of the world's largest civil IT effort, the £6bn NHS national programme for IT.

Electronic appointment booking is a massive cultural as well as technical challenge. Last month, the government admitted that not one primary care trust in England would meet the programme's first target: for half of their patients to be referred through the system.

However, one NHS community pioneering the new approach says that it has proved both technically feasible and popular with patients and staff.

A seemingly trivial detail that can make a lot of difference if it is collected accurately is the patient's mobile phone number. Earlier this year year, Whittington began sending out text reminders to patients booked in for operations seven days before their appointment.

The reminder contains no clinical information, just a reminder that they are due to attend. This had a dramatic effect on non-attendance rates. Of patients receiving text messages during a trial period, 5% did not keep their appointments. The rate for those who did not receive text messages was 13%. By offering patients a choice of time and date through Choose and Book, the rate of non-attendance should fall further."

Link: Society | Operation choice: e-bookings help patients select a hospital.

Should researchers have access to your EMR?

This article suggests that there should be greater access to information that resides in EMR systems. Not necessarily in office based EMR systems, but in larger EMR/EHR environments for example in health regions. This brings up a very important issue for discussion. Where should the information reside? More importantly, if that information exists in large databases, who owns that information?  The governance issues are critical. It may be that we begin at the regional level, but how does that translate into a local physician office at some time in the future? How does this impact patient privacy and does it potentially create more administrative load for the physician?

"Much of the focus on EMRs centers on reducing medical errors and costs and the benefits of making information portable. But the real benefit of digital medical records and a broader national network for exchanging them is the information that could be culled from the record to help researchers develop treatments for various diseases, according Greg Simon, president of FasterCures, a group that aims to examine the policies, technologies and regulations that could impede medical research.

Among its recommendations in the report, the group called for:

• Government and private sector groups focused on a national health information network and EMR standards development efforts to include representatives from the clinical research community;
• Any legislation or federal regulations on EMRs to include provisions that would make it easier for medical researchers to use such records;
• Standards that would allow EMRs to be used for research purposes;
• Healthcare IT vendors and organizations to work with clinical researchers and incorporate their needs into the architecture of electronic records and a NHIN;
• Groups with existing medical records databases to make them open and accessible to researchers.

Link: Report: Research community needs say in national EMR efforts.

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What is the Evidence to Support the Widespread Use of EMR to aid Clinical Decision Support?

This is a very topical and important question given the billions of dollars soon to be spent on EMR and already expended. Although I am a strong supporter of EMR, I am not aware of good evidence supporting the use of EMR and in many cases the evidence is anecdotal. There are many 'good stories' about how EMR has benefited care and physician and patient satisfaction that have been published in the media. Observing other industries, we intuitively know that if you have good tools that map to the pattern of care delivery and provide value at points along the way, there will be distinct benefits.

As a short-gap measure, are just computers and connectivity sufficient to move the physicians along the pathway to evidence based clinical decision making? From a practical perspective, when one is struggling to see one's patient load, if you are forced to live in two worlds (paper and electronic) simultaneously, you will be more inefficient. It is difficult to switch beteen the two media and make decisions in real time using a computer based 'smart system'. It still requires entering a clinical question and reading the response, processing the information and applying the information to the clinical state. The real value in the evidence will come once they flow naturally from integrated clinical decision support. E.g. I live in one environment for the majority of my work day (electronic), as I enter information into the computer (EMR), I am prompted (when appropriate) by information and the simultaneous ability to initiate decisions or actions.

 

In my opinion, there is no short cut. Good clinical decision support tools such as UpToDate are invaluable - it is important to note that these are not integrated, however the application of evidence and clinical guidelines requires that decision support allows the provider to remain time neutral or does not add significant time to the workload in order to provide care. Otherwise the solutions will be used by a motivated few and for the remainder, they will slip back to old habits that are quicker.

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