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

Holiday Wishes from CanadianEMR

With 2009 drawing to a close, I would like to take this opportunity on behalf of the team at CanadianEMR to wish all of our visitors and users a very happy holiday season and a successful 2010.

Alan Brookstone

 

(Image: Six month old white lion cubs)

Call for Papers - AHIC 2010 *Deadline Extended to Jan 11, 2010*

National Institutes of Health Informatics - AHIC 2010: Advances in Health Informatics Conference - Call for Papers is Open!
 
The First Virtual Health Informatics Conference in Canada
This inaugural Canadian conference will be held April 28 -30, 2010 at the University of Waterloo's Health Sciences Campus in Kitchener, Ontario, Canada ... and accessible via the Internet across the globe! The conference will focus on advances in Health Informatics research and education. AHIC will have fully peer-reviewed content and a single stream of presentations with an embedded think-tank session. Most importantly, it will distinguish itself by being a 'green' conference that supports both onsite and virtual participation (including presentation), and we are targeting a global audience.

The Call for Papers is open. Researchers, educators and students are encouraged to make their submissions and to attend the conference.

The CALL FOR PAPERS DEADLINE has been EXTENDED to Jan 11, 2010 - 12 Midnight Mountain Standard Time (MST).
The Categories for submission include both Foundational Contributions of novel informatics concept, methods, and tools, and the Application and Evaluation of informatics within the practical, day-to-day health care practice and education. Conference Themes include: (1) Progress in Health Informatics in foundational and applied research, (2) Advances in Health Informatics education, and (3) New developments in evidence-based eHealth policy development and implementation or healthcare practice.

The best papers from this conference will be invited to submit their work for publication in a special issue of the electronic Journal of Health Informatics (eJHI) http://ejhi.net continuing to support our principles of open access and being green.

For more information, please go to the AHIC 2010 Conference Website - http://ahic.nihi.ca

Is your computer network safe?

What happens in the event of an unexpected accident with damage to your physical office space? When hurricane Katrina struck New Orleans, many individuals lost their medical records which were stored in paper format. A web site was set up called KatrinaHealth to assist patients, pharmacists and physicians in reassembling their prescription information to provide some continuity to the medical and prescribing histories. However, for many, their medical records were completely destroyed. Physicians using ASP based Electronic Medical Records were saved from this disaster if their record databases were stored in remotely hosted servers. One of the definite benefits of having medical records stored off-site.

Sam Solomon, December 2009 - Parkhurst Exchange: On the morning of August 14, a 20-foot-long piece of concrete fell from the third floor of a suburban Toronto office building where several large group practices are located and smashed into the ground below, luckily not injuring anyone. City inspectors, concerned about other pieces falling as well, immediately evacuated and cordoned off the entire building. You might think this would spell disaster to the building’s two Family Health Teams and to the one preparing to move in in eight days. Without their records and computers and phones, how would they care for their patients? How would they even let patients know the building was closed? How would they refer patients appropriately until the building reopened?....

What are your thoughts about ASP (remotely hosted) vs. Local Installations for EMR systems? Do you prefer one configuration over the other? Add your thoughts by clicking on the 'Comments' link below

Unhealthy diagnosis for NHS IT! MD EMR Market Remains Healthy

There has been no shortage of bad news from the UK regarding the status of the National Program for IT (NPfIT) and 'Connecting for Health'. Now the knife is coming down and cuts will be made to a project that was touted a number of years ago as the largest international IT project ever.

December 10, 2009: Last weekend it seemed as though the death knell might finally be sounding as Chancellor Alistair Darling popped up on The Andrew Marr Show to call for cuts to the project, declaring that it is not a front line priority at this time. Well, maybe not from the point of view of the Treasury which sees the NHS programme as a cost encumbrance that would be a politically useful item to cut back on. But the Department of Health clearly has other ideas. After all, this is its flagship IT project, the biggest civil IT project in etc etc etc. So it's going to take more than Alistair Darling pre-announcing cutbacks to put a stop to that. When Health Secretary Andy Durham made a statement to the House of Commons he made that perfectly clear when he ignored Darling's assertion that the Programme was not front line critical and proceeded to sing its praises while lightly scarping £600 million from the (current) budget over four years - Special Report: Andy Burnham's unhealthy diagnosis for NHS IT

So, what does this all mean for physician EMRs in the UK? It is likely going to significantly stimulate the growth of existing vendors in the EMR market as the 'top-down' large system EMR strategies are scaled back. Connecting for Health (CfH) has been focused on the development of large level EMR providers known as Local Service Providers - LSPs. These vendors had committed to develop and deploy MD office solutions, but have had very little success (some statistics indicate that fewer than 200 MDs were willing to try these EMR systems, the most well known being iSOFT's Lorenzo). They were unable to convince MDs to migrate from their existing solutions for a number of reasons, one of the most important being a lack of functionality in their products in comparison to existing products currently in use.

One of the outcomes of CfH being scaled back is the simplification of choice. For the primary care trusts, they now have fewer potential options and will likely be aggressively seeking to work with existing EMR vendors that have clients in the market.

There are advocates who believe that the answer lies in the patient driven personal health record (PHR). Perhaps this is true, although we still have a long way to go to develop workflow processes that integrate PHRs into the delivery of care.

Parts of the Connecting for Health program have been a great success including GP2GP transfer of patient records, however for the most part, the top-down approach has not worked (again!). There is a difficult and uncomfortable balance that must be reached between desire to be in control and the development of policies that stifle growth and innovation and are ultimately viewed as political interference. This should serve as a very prudent warning to Canada. The large majority of healthcare in this country is delivered locally. Solutions need to meet the needs of local providers, yet also support the union of all care providers across the continuum of care ecosystem. While the need for national infrastructure is important at the large system level, we should be investing a significantly greater proportion of scarce healthcare dollars where 80% of the care is provided.

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

Podcast and Newsletter Schedule for 2010

Upcoming Podcast and Newsletter schedule for 2010:

Quarterly Roundtable Podcasts

• Q1: Mobile Healthcare
• Q2: Hardware Options for the Medical Office
• Q3: Privacy and Data Sharing

Weekly Podcasts

• Creating Successful IT Programs - Prof. Denis Protti
• Why are information exchange standards so important?
• Tax implications relating to the purchase of Hardware and Software
• Understanding Personal Health Records
• Update on the US EMR program
• Do you want to be a Physician and an IT consultant?
• Using speech recognition effectively
• Many more... 

Electronic Newsletters (January to April 2010)

• Data entry strategies - Using Templates
• Data entry strategies - Using speech recognition
• Optimizing the front office - Tips for staff and administrators
• Privacy and Security of patient data
• ASP systems vs. Local Servers - what is the difference
• Overview of national and provincial EMR strategies
• EMRs and Chronic Disease Management
• Patient access to EMR data

Add your thoughts or suggestions for topic ideas by clicking on the Comments link below

Does Canada have Federated EMR Paralysis?

Will geographic challenges and the decentralized nature of Canadian provinces and territories ultimately be the undoing of any attempts towards a national EMR strategy?

At a time that hard decisions need to be made regarding a national approach to EMR adoption and use, there has never been a greater need for leadership to ensure that sustainable and effective strategies be put in place. However, does the makeup of Canada work against any efforts to create sustainable policies?

Having been involved in numerous provincial and national programs over the past decade, it has been evident to me that any attempts to reach consensus have been fraught with difficulties. Quebec is frequently not at the table in a meaningful way and has the added challenges of the need for French or bilingual EMR solutions. Privacy, instead of functioning as an enabler to develop systems that protect confidential information while allowing the movement of appropriate data between patient and provider, functions as a barrier. [Privacy experts will take exception to this statement - however I witnessed first-hand the inability to share information between regional health authorities in British Columbia without complex information sharing agreements. These entities are theoretically all on the same side].

Australia has taken the novel approach of shifting towards a patient health record (PHR) approach to their national electronic health records strategy. After years of attempting to develop meaningful national policies, they have moved away from the top-down towards the bottom-up approach.

Is it simply the desire in Canada for everyone to be heard or is it the more ominous need for control at the provincial or regional levels that acts as the primary barrier?

As the US puts significant resources behind a committed strategy to enable EMR adoption at the provider level [not without its own challenges], Canada seems frozen and unable to move ahead. Perhaps what we need is a health czar such as Dr. David Blumenthal in the US! What we also need is a recognition that the needs from province to province are not significantly different from an information sharing perspective that we need entirely different versions of EMRs in each province.

Canada is being left behind by the US and is way behind many European countries in terms of the automation of healthcare. If we truly consider ourselves a first-world country, we need to move away from third-world strategies and put effective leadership in charge of the national EMR strategy. Without this, we will never create clinically seductive solutions and Canadian physicians and patients will remain mired in the disorganized world of the hybrid paper and electronic healthcare system.

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

Conversion from one EMR to Another - What are the Options?

If you are currently using an EMR and wish to change, adopting a new EMR system will require significant thought and planning in terms of data conversion strategies.

There are a number of mechanisms to convert data from one EMR to another:

1. Simple conversion: Manually re-enter the data into the new EMR. This is a time and resource intensive process, but does have the advantage of being able to clean the new data at the time of entry. There will be no unmatched fields or data conflicts. At a minimum, it should be possible to export the old records in the form of a .pdf file and attach the individual .pdf files to the patient record in the new EMR for reference purposes;
2. Vendor direct conversion: The new vendor undertakes to convert data in the old EMR system to the new system. This is usually a one-off process and can incur significant cost if the data structure in the old EMR is significantly different to the new system requiring a great deal of custom mapping between different data fields;
3. Conversion according to accepted data standards from EMR to EMR. In an ideal world, if all systems store data in a standard format i.e. exactly the same format and field in both systems, it should be a much simpler and less costly exercise to convert from one EMR to another. In the UK, this has been done using the GP2GP system. (Note: Using GP2GP, not all data is converted from one EMR to another and a data limit is imposed in terms of the amount of information transferred between systems. However sufficient data is transferred to have a fully functioning EMR patient record in the new system);
4. Third party conversion: Companies or organizations that have expertise in data conversion provide a service to convert EMR from one system to another. The challenge that these companies face is related to the way that data is collected and stored in the original system by the users;
5. Hybrid conversion: Certain discrete data is transferred from one EMR to another e.g. lab and demographic data and this is combined with a .pdf file for each patient record which is then attached to a patient record in the new EMR system.

(The prior is a summary of a presentation given in Vancouver on December 27th by David Ulis, Program Director for the Physician Office System Program in Alberta).

Does this cover the spectrum of data conversion? To add your thoughts and comments, click on the 'Comments' link below

Announcing 'Post Mortem' EMR and EHR Analyses

A new category of discussions has been added to CanadianEMR - 'Post Mortem Analyses'. The concept behind this category is to identify what has not worked with EMR and EHR implementations either in a medical practice or at the larger system level.

James Joyce (1882 - 1941) said, "Mistakes are the Portals of Discovery". This is a lesson we should not ignore or take lightly.

In talking with physicians, systems architects, project managers around Canada, my sense is that there is a huge thirst for information about the failures in Health IT. We know that there are physicians who have been unhappy with EMR implementations. Similarly, a large number of large system projects fail. However we never get to hear about these and develop effective mechanisms to avoid pitfalls in the future.

If I hear about a failure (big or small), I will post it in this section of the blog. If you have experienced an IT implementation failure, send me a description and let's invite others to weigh in and provide an analysis of why the project failed and what has been learned from the experience.

Send an email to alan.brookstone@canadianemr.ca

CMAJ: Canadian physicians playing "catch-up" in adopting Electronic Medical Records

How do we move Canada along more effectively in terms of the adoption and use of EMRs? This is the subject of a recent article published in the CMA Journal.

Canadian doctors lag far behind their counterparts in many other developed nations in adopting basic electronic medical records largely because the emphasis in Canada has been on “the big building blocks” of electronic health records, says Bill Pascal, chief technology officer for the Canadian Medical Association. “When you look at how far countries have moved towards a broader vision of electronic health information capability, Canada is not doing too badly,” Pascal says. Comparatively less attention has gone to promoting the uptake of electronic medical records in physician offices in Canada, he adds. The lack of financial incentives and support for physicians to make the transition from paper records is also an issue. Perhaps even more challenging than cost is the fact that “integration into workflow takes time, is likely to have a short term negative impact, and requires good change management practices to be successful,” says Khaled El Emam, associate professor at the University of Ottawa and Canada Research Chair in Electronic Health Information.

CMAJ: Canadian physicians playing "catch-up" in adopting electronic medical records

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

Dr. Steve Pelletier - What's the Benefit of an EMR in a Group Practice?

Dr. Steve Pelletier is a family physician with the Clarence Rockland Family Health Team. Two years ago, he was the driving force behind the amalgamation of two clinics and the development of a custom designed medical building with examination rooms configured for an EMR. Steve discusses the development of the clinic and how it was critical to the successful use of Electronic Medical Records.

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