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

OntarioMD Announces New Funding for EMRs

OntarioMD has just announced a new funding program to support EMR adoption. $236 Million will be available to both specialists and GPs to adopt EMRs in Canada's largest province.

OntarioMD.ca: Who Can Apply?

Community–based physicians, both family practitioners and specialists, who are not using an EMR that was acquired through a government program can apply for New EMR Adopter Funding.

New EMR Adopter funding is intended to promote and enable physician office transformation from paper-based to electronic medical records increasing timely access to patient information when and where it is needed.

The funding will include both one-time payments and monthly subsidies to support physicians with associated costs incurred over a 3-year period. In addition to EMR funding, the program also includes transition support services to assist physician practices in the necessary organizational changes when advancing information technology. These services are provided by OntarioMD at no cost to program participants.

Practices will be able to receive between $27,100 and $29,800 including a Readiness Grant, Monthly Subsidy (36-month term) and a performance grant per funded participating physician. For more details, go to: OntarioMD.ca - EMR Funding

To add your thoughts or comments, click on the 'Comments' link below.

Podcast: What's all the Fuss about ISO Certification for EMRs?

On October 3rd I published a posting entitled A Bombshell for EMRs in Canada - Classification of EMRs as 'Medical Devices' This elicited a significant response and comments from physicians and vendors alike.

The issue revolves around the impact of impending certification requirements by Health Canada in order for EMR software to meet Class 2 device classification.

On October 26th I interviewed Gary Folker, Managing Director, Business and Solutions Development at xwave and Chair of the ITAC Health working group on ISO certification. ITAC Health represents over 120 vendors in the healthcare IT market in Canada. Read more on the ITAC Health Blog - Patient Management Software Licensing Working Group

Listen to the Podcast:

To add your comments or suggestions, click on the 'Comments' link below.

Waste in the U.S. Healthcare System Pegged at $700 Billion in Report from Thomson Reuters

The numbers are hard to comprehend. A two trillion dollar healthcare system with approximately 1/3 of the funds being wasted!! I imagine that in an ideal situation, it may be possible to squeeze hundreds of millions of dollars of savings out of the system, however is this realistic? Even if a 10% improvement could be achieved, the numbers would still be in the $60-$70 Billion range.

Ann Arbor, MI October 26, 2009 - The U.S. healthcare system wastes between $600 billion and $850 billion annually, according to a white paper published by Thomson Reuters. The report identifies the most significant drivers of wasteful spending - including administrative inefficiency, unnecessary treatment, medical errors, and fraud - and quantifies their cost. It is based on a review of published research and analyses of proprietary healthcare data. "The bad news is that an estimated $700 billion is wasted annually.

That's one-third of the nation's healthcare bill," said Robert Kelley, vice president of healthcare analytics at Thomson Reuters and author of the white paper. "The good news is that by attacking waste, healthcare costs can be reduced without adversely affecting the quality of care or access to care.

Waste in the U.S. Healthcare System Pegged at $700 Billion in Report from Thomson Reuters

Do we have capacity in Canada to improve the efficiency of our healthcare system? How inefficient do you think the Canadian healthcare system is and where could we achieve the maximum reduction in waste? (technology or system related)

To add your thoughts, click on the 'Comments' link below.

US - Lack of Standards Limits Exchange of Lab Data

As reported in Healthcare IT News - the ability to exchange lab data will significantly limit the ability to demonstrate 'meaningful use' of Electronic Records in the US. Standards are viewed by many as a drudgery - boring, repetitive work that needs to be done by the technically inclined in order to connect systems and processes. However, without standards for lab data (as they are finding in the US), the ability to share information is very limited.

WASHINGTON – The HIT Policy Advisory Committee's information exchange workgroup learned Tuesday just how difficult it's going to be for doctors to exchange electronic lab results to qualify for federal "meaningful use" bonuses. Physicians can earn a potential $44,000 under the American Recovery and Reinvestment Act (ARRA), beginning Oct. 1, 2011, but they will have to show meaningful use of data, including the use of electronic laboratory results. One of the problems is that state laws regulate the exchange of electronic laboratory results, and standards don't exist to allow this information to flow easily between labs and physician offices.

According to experts, labs are required to pay for the exchange of data, so they build connections with larger providers first – leaving small physician practices on their own, since there aren't enough lab results to justify the interface. Physicians encounter barriers in exchanging lab results electronically | Healthcare IT News.

The same lessons can be applied to Canada.

I see this as part of a broader information exchange requirement - once we have lab data, how about a mechanism to send and receive referrals and consultation reports?

Add your thoughts and comments by clicking on the 'Comments' link below

What do we Know about Specialist Needs for EMRs?

An article published in the October 2009 British Columbia Medical Journal by PITO Program Director, Jeremy Smith advances our knowledge of EMR requirements for specialists.

PITO (Physician Information Technology Office - of British Columbia) is the organization responsible for the deployment of EMRs to approximately 4,000 physicians in the province including specialists and primary care physicians.

For the purpose of this article, Jeremy has divided the specialists into three continua:

Continuum one:

• Surgical specialties
• Longitudinal care sub-specialties
• Episodic care sub-specialties

Continuum two:

• Psychiatry
• Ophthalmology

Continuum three:

• Highly hospital-oriented specialties

Essentially the article looks more at the work processes that these specialties adhere to vs. individual sub-specialties as specific categories. This makes a lot of sense to me as specialists will be able to more easily identify their specific needs and then be able to select an EMR based on their work requirements. To read the full article, go to Specialists and EMRs.

To add your thoughts or comments, click on the 'Comments' link below.

GP Rating Service - NHS Choices

Rating services are here to stay in the UK and now extend to GPs.

The Department of Health has launched a controversial online rating service to let patients rate and compare GP practices via its flagship website, NHS Choices.

Patients can upload comments on how easy it is to get an appointment at a particular practice, how highly they would recommend the practice, how well patients are treated by staff and if they feel involved in decisions about their care.

The DH said the ratings service would give patients all the information they need to choose between England’s 8,300 practices, following the recent announcement that practice boundaries are to be scrapped.

View the NHS GP Ratings Service

In North America, we have RateMD.com - the unpopular and controversial web site to rate physicians across the US and Canada. What are your thoughts, should ratings be available and officially sanctioned for GPs and Specialists? Is it possible to achieve an accurate and dependable rating? To add your thoughts, click on the 'Comments' link.

Do Incentive Payments Linked to Outcomes Frameworks Improve Care Outcomes in Chronic Disease?

In a retrospective cohort study published in the British Medical Journal, questions are raised about the effectiveness of quality and outcomes frameworks on diabetes care in the UK between 2001 and 2007.

The study is an interesting analysis of the impact of incentives on performance in the UK for the designated cohort of patients. The evidence indicates that this is not simply a matter of applying incentives and a measurement framework and expecting that improvements will continue to be present. A fair amount of tweaking may be necessary.

Conclusions: The management of people with diabetes has improved since the late 1990s, but the impact of the quality and outcomes framework on care is not straightforward; upper thresholds may need to be removed or targets made more challenging if people are to benefit. Many patients in whom care may be suboptimal may not be captured in the quality and outcomes framework assessment. Effect of the quality and outcomes framework on diabetes care in the United Kingdom: retrospective cohort study -- Calvert et al. 338: b1870 -- BMJ.

To add your thoughts or comments, click on the 'Comments' link below

Governments Change Direction on Health E-records

Reported in Australian IT October 13, 2009, it appears that Australia is adopting a new ehealth national strategy. NEHTA is the Australian National eHealth Transition Authority and plays a role similar to Canada Health Infoway.

Australia is moving towards a "person controlled" electronic record - read (Personal Health Record - PHR) vs. a single national e-health record for every Australian. Necessary requirements in order to make this happen include a robust set of standards, a complete and accurate patient and provider registry (so that you can find the right doctor and associate that doctor with the right patient - a pre-requisite for the efficient sharing of information) and the ability to securely send a message between two systems or individuals. (This does not mean a secure network, as there are many other ways to transmit information securely over the regular internet using tools such as PKI - Public Key Infrastructure).

GOOGLE, Microsoft and other new providers will host Australians' electronic health records as the federal and state governments back away from funding a nationwide scheme. National E-Health Transition Authority chief executive Peter Fleming said the original vision of a single e-health record system had been abandoned in favour of "person-controlled" records that could be adopted more quickly. The Council of Australian Governments is yet to make a decision on the business case for individual e-health records put to it by NEHTA a year ago, but Mr Fleming said the health ministers were pushing the organisation to take "a far more commercial approach". Governments change direction on health e-records | Australian IT.

In an article published today in The National Post entitled 'The e-health trade-off', columnist Colby Cosh questions the role of Canada Health Infoway in terms of 'goading' Ontario to follow in the footsteps of Alberta's technological forwardness.

"What Ontarians may not have noticed is that Alberta's Auditor-General issued his annual report earlier this month, and it had a chapter on EHRs. What was the secret of relatively rapid EHR adoption out West? One answer might be "Surreal amounts of money." The Alberta A-G reported that his much less populous province has spent at least $615-million on electronic records, and that's just centralized investments; it doesn't include purchases by regional health boards. Another answer might be "Carelessness about trifling details, like patient privacy." The audit found, for example, that because of poor user-access management, 158 terminated Alberta health workers still had accounts they could theoretically use to tap into the NetCare database of medical records. Moreover, the NetCare installation in Edmonton was hit with a Trojan computer virus in May, compromising the records of up to 11,582 patients. No, being an early adopter isn't all peaches and cream."

What should we be doing in Canada with respect to the national eHealth strategy? Is the Canada Health Infoway Blueprint sufficient to achieve adoption and use of EMRs, EHRs and hospital based clinical information systems? Should the focus be on getting EMR adoption by physicians as a top priority? (as has occurred in many nations around the world) Canada is still very much a laggard in the adoption of EMRs - soon to be overtaken by the US with their huge push to get EMRs into the hands of >300,000 primary care providers.

To add your thoughts or comments, click on the 'Comments' link below.

Online Reviews and Ratings - How Much do they Impact Purchasing Decisions?

CanadianEMR has offered online ratings and rankings for EMR systems available in Canada for over 2 years. Through this time, we have seen progressive growth in interest regarding the EMR comparison comparison engine and ratings. So much so, that CanadianEMR consistently attracts 5,000+ visitors per month. The most popular areas of the site are the vendor profiles and the EMR comparison engine.

All well, but how are consumers using online review and ratings to make purchasing decisions?

An April 2009 study by Opinion Research (.pdf) found that we do trust online reviews and ratings when shopping for products. The study revealed that '84 percent of Americans say online customer evaluations have an influence on their decision to purchase a product or service. A sizeable number of respondents (50 percent) relied on online reviews in the first stage of their buying cycle'. According to Opinion Research, “This is critical for companies to understand as they fight to work their way into the consideration set of consumers and look for ways to be ever-present through a variety of channels and media outlets.”

Commonly checked online forums included:

• Company websites (71 percent)
  
• Online rating systems (57 percent)
  
• Government/consumer advocacy sites (54 percent)

These types of services should be seen as increasingly more important by vendors and potential purchasers of EMR software.

At CanadianEMR we are committed to creating rich interactive communities focused on providing information on the EMR market and on other products and services that physicians and medical practices require to effectively adopt and use technology in their practices.

Your thoughts and comments are welcome in terms of what you would like to see in the future on CanadianEMR. How do we improve our rating system? What else would you like to see or participate in?

Click on the 'Comments' link below to provide your feedback.

Microsoft NHS Resource Centre - From the consulting room on YouTubing training

Traditional training for EMRs is costly and time consuming (and generally not on-demand as needed). What should one do when staff turnover - it is a significant headache retraining new staff to use EMR software and usually depends on the most appropriate staff member(s) assisting the new person with training resulting in lost office productivity.

So, what is one to do? One solution is to develop a series of video clips that can be loaded up on a site such as Youtube. UK physician Dr. Neil Paul explains:

Traditional training: expensive and time consuming “Of course, you can buy in training. But not everyone attends and it's often the ones that need to go most that miss it.” Turnover of staff can be a problem. New staff tend to get trained in-house by non-expert trainers who may not know it all themselves and aren’t necessarily good teachers. A recent survey of practices that I carried out on the usage of one piece of software turned up an email from a GP who liked the software but complained that the text was too small. Introducing her to the ‘fit text to screen’ button has changed her life - a superb example of how even small tips can make a huge difference. In the same survey, several practices asked for features to be added to the product that were already in it and had been for some time.

Now, this could have happened to any product so I'm not singling it out. Of course, you can buy training off the software company or an independent if you can afford it. Often, however, the training itself can be a pain as it usually happens in-hours and involves closing the surgery or taking staff out. Not everyone attends and it's often the ones that need to go most that miss it. And even if bought-in training is great, several years on, after numerous updates, it can be difficult to know who knows what and who is using which bits of functionality

Microsoft NHS Resource Centre - From the consulting room on YouTubing training.

To add your thoughts or comments, click on the 'Comments' link below