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

NEJM: Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?

Excellent article published in the New England Journal of Medicine on the benefits of electronic clinical documentation.

NEJM - March 24, 2010: The United States is about to invest nearly $50 billion in health information technology (HIT) in an attempt to push the country to a tipping point with respect to the adoption of computerized records, which are expected to improve the quality and reduce the costs of care. A fundamental question is how best to design electronic health records (EHRs) to enhance clinicians’ workflow and the quality of care. Although clinical documentation plays a central role in EHRs and occupies a substantial proportion of physicians’ time, documentation practices have largely been dictated by billing and legal requirements. Yet the primary role of documentation should be to clearly describe and communicate what is going on with the patient.

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Clinicians need to take back ownership of the medical record as a tool for improving patient care; such a move could have many benefits, including reducing the frequency of diagnostic errors. External requirements for EHRs should be minimized, and physicians, members of their support staff, and patients should be engaged in reengineering documentation, with the goal of building a more distributed, reliable, and content-rich yet succinct and efficient system. Diagnosing illness is one of our most important professional responsibilities, and patients justifiably expect us to perform this difficult task well. Electronic documentation represents a pivotal tool that can help us to fulfill this responsibility.

Read the full article - NEJM

Healthcareitstrategy - An EMR that increases productivity

This morning, I had an opportunity to talk with Paul Roemer who writes an interesting blog called healthcareitstrategy. There are many physicians who have built their own EMR out of a desire to improve their internal practice operations and care delivery - often at significant cost. He published a guest blog from an oncologist who discussed his approach to developing an EMR. Conceptually very interesting because his strategy was all benefits and outcome based. If there was no value in a specific feature for operations or care delivery, he did not build it in.

The dream is always to build something that is universally useful to a wider group of physician users, but the nuances of specialty requirements, differing workflows and interoperability with the multitude of external providers and systems can be a significant challenge. That being said, this posting is worth reading.

The following is a guest blog by James T. Loynes, MD. During a recent call he told me about an EMR he wrote for his oncology practice. My initial thought was, “Just what we need, another EMR.” The more I listened, the more I thought he had something different, something that actually was built towards an eye for best practices. I asked him if he would tell you about it. The rest of this is his. The Path to Excellence Is Under Construction

Read the full posting

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CMAJ: Electronic health records a “strong priority” for US government

As the healthcare reform movement gathers steam in the US, significant investment is being made in electronic health records to support the national agenda. Despite all of the challenges in the US with a dominantly for-profit competitive healthcare system, the national strategy is truly national. From establishing standards at the national level to developing policies that are applicable in all states to developing certification programs that allow solutions to be sold nationally - there is a concerted effort to move the entire system into the digital age.

Contrast that to Canada - many provinces and programs are currently stalled by scandals, budget restraints and localized provincial programs for EMRs. There is no true national strategy.

CMAJ March 23, 2010: Two years after Barack Obama’s presidential campaign pledge to vastly increase usage of electronic health records (EHRs), the White House is following through. The Obama administration is implementing aggressive and expensive plans rooted in the president’s belief that EHRs are crucial to health care modernization and cost containment, says David Blumenthal, the Harvard information technology expert who serves as the United States government’s national coordinator for health information technology. “It’s a very strong priority. The White House stays closely involved with our work,” Blumenthal said in an interview. “They’ve been extremely supportive.” Key officials including the president’s chief of staff, budget chief and health secretary have displayed a “very tight alignment” regarding EHRs, Blumenthal notes. Congressional support is also strong, he says: “It’s remarkable how much they seem to get it.” CMAJ: Electronic health records a “strong priority” for US government.

How do we get Canada back on track? I believe it is time to be brutally self critical. Canada's EHR/EMR program is 10 years old. What are lessons learned? Which of our initial assumptions were correct nationally and provincially? Are we focusing our energies and limited resources in the right areas? We need to admit our mistakes, course correct and move on.

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

Case Study on Use of Mobile Technology - Mount Sinai Hospital

At Toronto’s Mount Sinai Hospital, physicians are using iPhones to access the hospital clinical information system. They accomplished this by developing an in-house iPhone application called VitalHub which gives physicians secure, remote access to patient records, test results, vital statistics, and medical literature from its internal data network. The iPhone platform is gaining ground as more physicians adopt smartphones with decent sized screens (providing an advantage over the Blackberry devices that are most commonly used).

In an upcoming roundtable podcast, we will examine the use of mobile technologies to provide care and how these devices are being adopted and used by physicians.

“Our goal is to provide the cutting-edge best medicine, best teaching, and best research,” says Dr. Thomas Stewart, Chief of Medicine at Mount Sinai. “We need something that’s going to allow us to change rapidly. Five years from now, the medical world is going to be very different. With iPhone, we have a platform that allows us to adapt."

Read the full case study

Have you had any experience using a smartphone to access patient records or provide care? Share your experiences by clicking on the 'Comments' link below.

US - NIST Health IT Standards and Testing

The National Institute of Standards and Technology (NIST) has released the first of four installments, called Waves, of new test methods for ensuring electronic health records systems comply with meaningful use requirements. NIST is responsible for leading the development of the core health IT testing infrastructure that will provide a scalable, multi-partner, automated, remote capability for current and future testing needs.

The objective of the Health IT Standards Testing Infrastructure Project is to harmonize the efforts of healthcare standards test development and delivery to meet the demands for conformance and interoperability within the healthcare domain. Health IT Testing Infrastructure - NIST Health IT Standards and Testing.

Technology Based Stethescope Released by Littmann

Technology for Doctors: No tool in the physician’s arsenal is more iconic than the venerable stethoscope. In February, 3M introduced a new model that looks like a traditional stethoscope but is packed with technologies more often associated with computer peripherals. The 3M Littmann Electronic Stethoscope Model 3200 is a next-generation auscultation device with Bluetooth technology that transfers heart, lung and other body sounds wirelessly in real-time to a PC where they can be further analyzed, attached to medical records, or reviewed online with colleagues. Read the full article

Have you had any experience using tools that are connected to your PC or EMR?

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User Experience - Conversion from One EMR to Another

When choosing an EMR, we often tend to think of new users who are purchasing an EMR for the first time.  The invisible cost of implementing an EMR is the time taken to input all the data, clinical notes, lab results, scanned documents etc. If the data is not transferable to a new EMR system, there is a huge cost and complexity in re-entering the data. So, what should one convert? How difficult is the process of converting to a new EMR system and what are the other key questions that should be asked prior to the conversion? Dr. Gunther Klein is a family physician in Campbell River, British Columbia and discusses his experiences.

Listen to the podcast

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One Patient, One Record Symposium - Ottawa - April 6, 2010

Following a highly successful event in Toronto in 2009, Dr. Kevin Leonard, Associate Professor at the University of Toronto and the Founder of Patient Destiny is holding a one-day symposium in Ottawa April 6th in partnership with the Canadian Association for People-Centred Health (CAPCH).

The event will include a keynote by Dr. Daniel Z. Sands: “The Patient and the Physician Face Illness in the e-World” and Khaled El Emam: “What Does the Canadian Public Think About the Privacy of Their Health Information?”

To register for the symposium, click here

The Importance of Policy to EMR Success Provincially & Nationally

Last weekend I was watching a show on TV about the failure of policy in the US to reform the school education system. Under the Bush administration and pre 911, an education bill was passed with strong bi-partisan support to improve the education level of children with respect to Reading, Writing and Arithmetic.  Payment incentives to the states were tied to achieving certain pass levels for those subjects and the more children that passed, the more funding the state received. Sounds like a good policy and it should have driven success.

However there were two fundamental problems. No standard was set at the national level that the individual states had to achieve and the only two measures that were required under law were reading and arithmetic. What resulted was that the states, instead of raising the bar to require higher levels of performance actually reduced the standards for these two subjects so that more students could pass. In retrospect, this is understandable behavior as it increased the federal payments for education. However, it is now seen as a significant failure of policy at the national level.

Jump north of the border and consider what we have done with EMR policy in Canada over the past 10 years. Guidelines were established for EMR that made recommendations to the provinces for EMR functional requirements, however a national policy was never established to require all provinces to use the same messaging standards for EMR-to-EMR and for EMR-to-Other data exchange. In addition, policies were implemented piecemeal without establishing national goals for adoption resulting in some provinces moving ahead rapidly and others still without an EMR program in place 10 years later. Instead of one large EMR market in Canada and a healthy EMR industry, we have a fragmented market, vendors struggling to maintain certification levels in individual provinces at the expense of focusing on making their products better for end-users and key fundamental requirements for success still not in place - namely EMR-to-EMR messaging standards and ePrescribing.

Will we see growth in adoption and use of EMRs in light of these policies? I am convinced we will, particularly in provinces that have committed funding, bodies to support adoption and growing peer influence. Could we be more successful? Without a doubt. However, in my opinion it cannot happen without effective policy being developed at the national level which in turns drives and encourages the right outcomes at the provincial level.

In order to establish good national policy we require strong leadership with respect to EMR adoption and use, something that at this time does not exist. And that my friends and colleagues is the fundamental problem.

Do you agree or disagree? To add your thoughts or comments, click on the 'Comments' link below.

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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