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Why Have Practices Yet to Adopt EMRs?

One of the great things about the web is the ability to easily learn from insights and experiences of others. Brandon Betancourt is practice manager for a paediatric pratice in Chicago and writes and great Blog called Pediatric Inc. One of his most recent posts is Seven Reasons Why Medical Practices Have yet to Adopt EMRs

He also found a great video clip on TED (see below) which is really worth watching regarding leadership. It is quite applicable in the Canadian context with respect to EMRs.

Healthcare Interview - Canadian Healthcare Network

On April 8, 2010 I was interviewed by Colin Leslie, Editor of The Medical Post about EMRs. The article was published on the Canadian Healthcare Network and is republished on CanadianEMR in .pdf format with the permission of canadianhealthcarenetwork.ca

Excerpt:

Q: EMRs in physicians’ offices today are an improvement over paper charts. But when it comes to communicating with the larger health-care system, in many parts of Canada it seems like EMRs are still interfacing with paper-based processes. Is that a fair take? 

Yes, to an extent. The average physician in their practice probably connects with up to 40 or 50 different entities over a year. Those would include ancillary care providers, physiotherapists, occupational therapists, the hospitals, the lab systems (and) other colleagues. So there is an incredibly comprehensive network of exchange that takes place. There are a lot of components in the system that need to be enabled in order for that information exchange to happen electronically. We’re at the phase of: We’ve certainly got some of the cars for the roads but not all the roads have been built—and there’s some places you just can’t get to. We depend in Canada on paper to a large degree because there is no formal electronic process available at the moment.

Q: So, we need standards?

Yes. One of the challenges we’ve got in Canada is that we don’t have a national standard established for data exchange for EMRs, and this covers a few areas:

• First, the ability of an EMR to communicate with an EMR. So, for instance, I’m a GP and I need to send to a specialist.
• Second, the ability of an EMR to communicate with a hospital system, so I can refer patients for an X-ray or other investigation.
• Third, the ability to transfer data from one system to another one that is different—for patients moving from one practice to another. (If the EMR systems are different) that may require printing out a copy of that patient’s record from one EMR, then handing it to the patient or sending it to the other practice, and they’ve got to re-enter some of that data into the system.

Download 'The Healthcare Interview' (.pdf)

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American College of Physicians IM10 - Electronic Medical Records

Last week, I had the opportunity to attend and participate in the American College of Physicians Internal Medicine (IM10) meeting held in Toronto.

With all of the activity currently taking place in the US to develop programs that will fund and support meaningful adoption of Electronic Records in physician practices, there was a strong focus on this topic, both as part of the formal curriculum and presented in an EMR forum with presentations on selecting an EMR, understanding meaningful use, practical tips for EMR adoption and use and more. The sessions were all well attended.

Further information and slide presentations will be provided as they become available from the ACP.

The AmericanEHR Partners Program was also pre-launched at IM10 for internal review and feedback.

To learn more about AmericanEHR Partners, listen to the Podcast

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OAG Electronic Health Records in Canada | An Overview of Federal and Provincial Audit Reports

The office of the Auditor General today released a long awaited report on the state of Electronic Health Records in Canada. Important challenges are identified including the adoption and implementation of EMRs in doctor's offices.

Challenges include:

• Achieving adoption goals
• Realizing benefits
• Upgrading systems
• Sharing personal health information
• Consumer health solutions
• Funding

With respect to EMR adoption by physicians, the AG report states:

"A 2007 study reported that a limited number of Canadian primary care doctors use computerized systems in their offices to communicate and share information. Unless there is a significant increase in this number, the potential benefits of EHRs will not be fully realized. How can the number of primary care doctors using computerized systems be increased significantly?"

Read the full report

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National Post - Avoid the boondoggle!

To be successful in Canada with Health Information Technology including EMRs, we need to get back to basics. This is not about getting projects completed or getting treasury departments and bean counters off the backs of those who need to deliver on commitments. This is about care for Canadians and making sure that we use our resources well. In summary, extracting clinical value for the benefit of patients (unfortunately an often forgotten stakeholder in this equation).

The following is an excerpt from a just published article that I wrote for The National Post.

National Post - April 12, 2010: It’s hard to know exactly how many dollars Ottawa and the provinces have spent so far on the grand plan to bring electronic health records (EHR) to Canada’s health-care system. Supported by Canada Health Infoway, the federal-provincial agency promoting EHR, a rough count suggests the total to date runs to at least $2-billion, with much more to come. The last federal budget alone committed another $500-million. As Terence Corcoran stated in a recent column, “EHR is one of those great blue-sky ideas that seem sound and logical.” The objective is to have built an electronic health record for every Canadian — from prescription history to hospital visits, from family doctor records to major surgeries. As a physician and long time proponent of the use of information technology in health care, I am frustrated by the lack of progress on EHR, despite the billions spent.

Read the full article - Avoid the boondoggle

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Trouble with Quebec’s Electronic Health Network & Unsubstantiated Claims

Recently a number of articles have seriously questioned progress of provincial and national EHR programs, however what I find more distressing are the unsubstantiated claims regarding time savings and improvements in efficiency particularly with respect to physicians. This April 9th article quotes the Parti Québécois health critic as stating that electronic records should save doctors 20% of their time. Currently there is only anecdotal evidence of the time saving impact of Electronic Records (and here I am talking about the EHR, not EMRs in doctor's offices). While I believe that electronic processes will improve efficiency if well implemented and refined to ensure that workflow issues have been resolved and the underlying paper processes have been fully transitioned, doing this properly takes a huge amount of effort and commitment. 

The Gazette - QUEBEC – The provincial Health Department is promoting electronic health records as a way to hold down costs and make the province’s health system more efficient. But an access-to-information request by Bernard Drainville, the Parti Québécois health critic, found Quebec ranks 10th among the 10 provinces in developing its leg of the Canada Health Infoway. Launched in 2006, the program calls for programming individuals’ medicare cards so a doctor, a hospital or a pharmacist can have instant access to information on prescriptions, allergies, medical tests and imaging results. Once in operation, Drainville said yesterday, electronic records should save doctors 20 per cent of their time, allowing them to see more patients. Read the full article - Quebec’s electronic health network ailing

Unfortunately, the promise of information technology and EHR clouds the thinking of politicians and health system planners alike. Without resolving underlying problems (and understanding exactly what physicians and other caregivers do at a very detailed level on an encounter-by-encounter basis), it will not be possible to achieve the potential improvements in efficiency and care delivery.

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AmericanEHR Partners Program Announced by ACP and Cientis Technologies

New Internet-Based Resource to Support Health Information Technology Adoption

April 8, 2010 - Washington - A collaboration developing a new Web site to help medical practitioners compare electronic health records (EHR) systems was announced today by its founding partners, the American College of Physicians (ACP) and Cientis Technologies. The free, web-based resource, the AmericanEHR Partners Program, will help healthcare professionals compare, evaluate, select and learn how to use certified EHR systems effectively.

“The objective of AmericanEHR Partners is to provide a credible, easy-to-use national resource for physicians who are selecting, implementing or using an EHR,” said Dr. Alan Brookstone, CEO, Cientis Technologies.

“ACP is excited to provide the medical community with this new, unbiased resource on EHRs,” said ACP President Joseph W. Stubbs, MD, FACP.

Download a copy of the Press Release

ACP Contact:
David Kinsman
(202) 261-4554
dkinsman@acponline.org

Cientis Contact:
Alan Brookstone
(604) 813-6729
abrookstone@cientis.com

CMAJ: The pocketbook impact of electronic health records

Just published in the CMAJ - this article questions the value of EHR in a fee-for-service environment as the drivers for adoption could have a negative impact on reimbursement.

April 7, 2010....There is also the question of physician motivation to invest time and money to adopt a system that may reduce their contact with patients, either because adopting EHRs draws physician attention away from patients during an appointment, or because it reduces patient throughput due to the time needed to learn a new system, says Ludwick. "There's a disconnect" between EHRs and conventional fee-for-service payment structures. CMAJ: The pocketbook impact of electronic health records.

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Cell Phones & EMRs - An Analogy

Over the last few years, there has been an increasing awareness of the dangers of driving a motor vehicle while typing on a cell phone. Whether dialing a telephone number, or sending text messages (or email), doing this while driving is extremely dangerous as it distracts the driver from concentrating on the road.

In fact, texting while driving has become such a common practice, that until recent legislation in many provinces, it was not uncommon to pull up alongside a driver at a stop light only to see that individual doing everything but focus on their driving. Watch this video on YouTube of a bus driver texting while driving and rear-ending a vehicle on a highway. Scary stuff!

Perhaps the analogy is a bit extreme, however the majority of EMRs use keyboards for data entry. For most people, typing requires a significant degree of concentration, particularly if undertaken in addition to having a conversation. In the pressure filled world of the 10 minute encounter (in GP settings), data entry is just on more thing that the multi-tasking physician is required to do when using an EMR.

There are a number of ways that physicians get around this challenge: 

• They type all of their notes by interrupting the flow of conversation through the encounter;
• They go through the entire encounter and then record the notes at the end;
• They use speech dictation which is then transcribed into the EMR by a third party (doesn't work very well with templates or highly structured EMRs);
• They use alternative mechanisms for data entry such as tablet PCs and other touch interfaces.

Bottom line - this is a problem. There are very few people who can touch type while simultaneously giving full attention to a patient during a clinical encounter. It is not the same as having a social conversation. Physicians are juggling many pieces of information while trying to make a diagnosis - add the keyboard and there is less capacity to think.

There are many individuals who have developed their own style of using the EMR and the keyboard while managing patients safely and effectively, however it is a difficult skill to learn. Usability of EMRs is critical if clinicians are to extract the most out of them.

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