(This article is one of a series titled 'The Innovators' - EMR success story: Sustainable rural care built from the ground up)
Dr. Werner Oberholzer can barely contain his enthusiasm as he shows a visitor the electronic medical records system that he and his colleagues created as a key component of their region-wide primary-care team, here in rural southern Saskatchewan. Thanks to the EMR, which Dr. Oberholzer and his colleagues built essentially from scratch, their Rural West Primary Health Care Team is an admirably smooth operation, despite consisting of more than 17 practitioners—including two doctors—working at three separate facilities. It’s also admirable because of the challenge of serving more than 7,000 patients spread over 14,000 square kilometres, an area more than twice the size of Prince Edward Island.
As soon as information is entered into a patient’s file on the EMR, Dr. Oberholzer or his wife and colleague, Dr. Nelly Helms, can read it online and determine what they wish to do for that patient. “I can pick a name of any member of my primary-care team and send instructions to them,” says Dr. Oberholzer, who is also on Saskatchewan’s provincial e-health committee. “We spent hundreds of hours to make these forms and templates. We changed them with the designers to suit our function. I scanned all these forms in for different reconciliation forms, the medication, dosages.”
He gives a patient with diabetes as an example. The nurse doing a home visit can hover her computer’s cursor over an information field — related to BMI or blood pressure, for instance — and a screen pops up to tell the nurse what information Dr. Oberholzer wants. If the patient needs to see a specialist, the team can easily print out a summary to send to that doctor. And with a few simple clicks, a summary of the patient’s medications, immunizations and other info can be sent to a pharmacist’s iPad.
The doctors maintain control over every patient’s record, and can block or narrow what other caregivers can see in the EMR. “My pharmacist can put the medications in,” says Dr. Oberholzer. “I can say, ‘I agree with that.’ ” As well, they can use the EMR to generate reports on any topic — for instance, their 20 most common diagnoses or tests, or the top drug allergies. In terms of the EMR system’s impact on the care he provides, Dr. Oberholzer says: “If you can’t measure it, you can’t manage it. If I don’t have a target goal to start off with, then I don’t know where I’m going.” Moreover, since each physician needs to sign off on the chart of every patient seen that day, “if I have a task yet to do for the day, it lets me know.”
In 1998, Drs. Oberholzer and Helms joined many other South African doctors and left their homeland to take up practice in rural Saskatchewan. They settled in Radville, where their health-care team has its main base. It’s in prime grain-growing country, about 90 minutes south of Regina, that abounds in unobstructed views of rolling hills and roads stretching for miles in all directions.
When they arrived, there was no other doctor in town. Almost immediately, Dr. Oberholzer began thinking about ways to improve health services for their patients. He began lobbying the province to build a new health centre, since the existing one was cramped and “literally falling apart.” (After 10 years, lobbying and fund-raising have paid off, as a recent groundbreaking ceremony kicked off what is expected to be “a one-stop shop” in a $12-million facility scheduled to open by the end of the year.)
As the doctors in the neighbouring towns of Pangman, Bengough and Coronach left their practices in recent years, the workload for Drs. Oberholzer and Helms continued to increase. Today, they each see from 45 to 75 patients a day and they have come to rely on allied health professionals for solutions. A few years ago, pharmacist Kim Borschowa and Dr. Oberholzer attended a chronic disease management workshop on clinical practice redesign that the Saskatchewan’s Health Quality Council hosted. Almost immediately they began collaborating on the care of their diabetic patients along with Leila McLurty, an experienced community health services manager who splits her time between Pangman and Bengough, who was also interested in providing better care. They all recognized that they needed to find a way to provide care to an ever expanding patient population (due to the physician exodus), spread over a large geographical area. Community meetings were soon held to determine which services were needed most.
A properly designed EMR would be crucial. In May 2010, the Rural West Primary Health Care Team officially launched. It consists of more than 17 practitioners including the two doctors, a dietitian, two pharmacists, a nurse practitioner, home-care and diabetes nurses, plus administrative staff. The team also teaches nursing, pharmacy and first-year family medicine students from the University of Saskatchewan who come for two to six weeks to experience rural remote medicine.
Going the distance
An unavoidable part of caring for so many patients over such a large area is the need to get behind the wheel. So, one day a week, Dr. Oberholzer drives several hundred kilometre to see patients — to Bengough then to Pangman, then back to Radville — often arriving home around 10:30 at night. Typically, Dawn Geiger, a team assistant who travels with Dr. Oberholzer to the communities, types patient complaints and information into the EMR after meeting with the nurses in the health-care centres and nursing homes. From its base in Radville, the team also provides 24-hour emergency care for the region.
The EMR is key to the team’s success, but so are the face-to-face meetings that build trust and knock down the walls of professional territorialism. “The EMR makes a big difference because, say I get a patient coming in and they don’t remember what they discussed with the doctor,” says Borschowa. “I can look it up and see that, yes, they discussed this.”
Dr. Oberholzer spoke at length about his team’s strengths at the recent Saskatchewan Medical Association meeting. Dr. Phillip Fourie, the SMA president, says Dr. Oberholzer “is well ahead of the curve. He’s where we want to go with primary health care,” adding the province lacks a province wide EMR system. Not that everything was easy with the team’s setup, far from it. The transition to the new EMR “was absolutely horrible because there was no one to tell us how to use this thing. The whole office was in an uproar,” recalls Dr. Oberholzer. But after six months of fine-tuning, all agreed the EMR and instant access to each other as caregivers is invaluable. “Now that the team is in place, we’ve brought access and health care to areas where they thought it was not possible or sustainable,” says Dr. Oberholzer. “And we’ve empowered the health-care providers within the team to perform to the best of their abilities to promote higher quality medicine. We can now design the care around what the patient needs instead of forcing the patient into a model that’s not suitable to him or her.”
To sum up his approach, he says, “Anything that doesn’t change goes stagnant. You either make it better or you leave it.”
Deana Driver is a freelance writer in Regina.