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

Highlighter Scanning Trick — Dr. Ian Pun

The following post was submitted by Dr. Ian Pun:

Dr. Brookstone, excellent summary of EMR usage in your podcast.

I like the point about the doctors are working around the EMR rather than in it, doubling your work. Habits are hard to change because of the volume of old charts involved.

Perhaps everyone should have their own personal scanner. I scan the patient chart myself when I’m seeing the patient (so it’s done only once for their first “EMR” visit). It’s really fast with the Scanscap S510 scanner. Feed and press a button. If the chart is really thick, I may just scan the last couple of years. In fact, I’ve scanned probably more than 100,000 pages. I already wore one out (I think I have to replace the feed separator PAd assembly). I still have two scanners left, even a newer S1,500. I stick a highlighter to the scanner so it marks the back of the page, indicating it is scanned. The EMR will work better when all information is in it. My staff then attaches the scanned .pdf into the eChart.

After a year, my documents folder is 2.5GB in size. So, 25,000,000 KB (at 50 KB per page = 500,000 pages.) Wow! But that includes faxes and some pages may use more memory. Probably a more accurate estimate is 250,000 pages. I have 20 x 2m shelves full of charts. That’s 20 x 200 cm = 4,000 cm of paper. 4,000 cm x 500 pages/5 cm = 400,000 pages. I have probably scanned about half my office’s charts this past year. That's just me in my solo office. It should get easier from now.

Let me share with you my highlighter trick to mark the paper as it is being scanned.

New paper reports are scanned into the EMR immediately. This has saved a lot of room and I don’t need to buy more expensive shelves/folders/paper.

Ian Pun MD
GP, Toronto

Share your experiences and tips by sending an email to info@canadianemr.ca

CMAJ — The Challenge of Shopping for Electronics

Just published in the Canadian Medical Association Journal, this article highlights the challenges faced by family physicians (and equally, specialists) when selecting an EMR and purchasing hardware and software.

At CanadianEMR, we frequently receive requests for information on the cost of EMR systems. What should one pay for a solo, two-physician, or multi-physician practice EMR system? This is an impossible question to answer as there are multiple variables, e.g. number of computer terminals and software licenses, hardware preferences of the practice, network costs, etc.

The advice that I always provide when asked about cost is the following:

• First determine the needs of your practice with respect to the EMR. Wherever possible prioritize what is most important to you. If you have limited keyboarding skills and wish to use dictation or speech recognition to enter clinical data, you will need an EMR that manages narrative notes vs. one that is good at recording discrete data (some EMRs can do both). If a large proportion of your patients suffer from chronic diseases, you will need an EMR that is able to record, display, and recall patients and generate reports or flow sheets for chronic disease management. If you prescribe a lot of medications, ensure that prescribing and medication management are a top priority for the EMR system you will be selecting.
• Once you have decided upon a shortlist of EMR products by discussing with colleagues, getting guidance from a provincial program (if available in your province), and having the software demonstrated to you by vendors, the next — and most important — step is to do site visits and see how the software is used in practices that are similar to yours. A few days expended (even if there is some loss of income and some travel expense in visiting practices who use the software) is a worthwhile price to pay if you are able to determine the most appropriate system for your practice. Do not just listen to what the vendor has to tell you. In this market it is buyer beware. It is the vendor's job to sell software and it is your responsibility to do the due diligence that you are getting the most appropriate software.
• Price should not be your first determinant when selecting an EMR. This is something to negotiate with your vendor(s) of choice once you have done a full evaluation. The cheapest system may seem like a bargain at the time; however, if you forgo necessary functionality to save a few dollars or squeeze the vendor to get the price down to a minimum, you will invariably pay in terms of lost productivity, insufficient training, or inadequate support included in the price of the software. Vendors have to make a profit to stay in business. If you are getting a deal that seems too good to be true, stop and go over the numbers again. What you do not pay up front may cost you more in the longer term.

Share your experiences when purchasing an EMR? Do you agree with my approach or have you made the decision based more heavily on cost? Click on the “Comments” link to add your thoughts and feedback.

Tax Tips for Physicians and Physicians in Training — 2011

[The following information is provided by Dr. Brian Cummings and is published on his behalf with the consent of the Canadian Medical Association. For a number of years, Dr. Cummings has written and updated a Tax Tips guide - Ed.]

I have updated Tax Tips for the Physician and Physician in Training and the 2011 version is now available online. The document, “Tax Tips for the Physician and Physician in Training”, has grown considerably in size. It is posted year-round on the cma.ca website. It contains answers to all the relevant tax questions that a practicing physician or physician in training may face. It is printable and one can search the document. The 2011 version is now available:
 
English:  http://www.cma.ca/index.php/ci_id/49620/la_id/1.htm
French:  http://www.cma.ca/index.php?ci_id=49620&la_id=2
 
Click “Tax Tips for the Physician and Physician in Training — 2011 edition” towards the bottom right side of the respective page.
 
Organizations including the Canadian Association of Pathologists (CAP), Ontario Association of Pathologists, CAIR (Canadian Association of Interns and Residents), as well as a number of provincial house organizations (e.g. PARI-MP, PAR-M, etc.) and other groups have posted this link on their website for the benefit of their respective members. The document is copyrighted by the CMA, so any reproduction, must be cleared with them first.

If you would like to submit a comment, please click on the “Comments” link below.

Does Your EMR Get in the Way of the Patient Encounter?

There has been much written about EMRs and the propensity for the technology or the device to get in the way of the patient encounter. This can be a physical limitation due to the layout of the examination room, desks, computers, monitors, etc., or it can be more of a functional limitation due to the usability of the software and the clinician’s comfort with typing or using other mechanisms to get data into the EMR.

Talk to physicians who have used EMRs for a long time and they will tell you that the EMR is second nature to them, just as with a pen and paper chart — they no longer have to think about what they need to do. It is just the way they practice medicine. Obviously there is a significant degree of variation in terms of individual comfort with the EMR and the computer(s); however, universally longtime users get into a routine that allows them to treat patients most effectively.

I have used a number of different EMRs in clinical settings. Each has its own strengths and weaknesses. However as a touch typist, I find it much faster to type rather than write, and reviewing past medical history, medications, lab results, and consultation reports is significantly faster and more accurate in all the EMRs that I have used. Screen positioning is key so that the patient feels part of the encounter and can participate in the discussion. I also frequently use Google images to bring up an anatomical drawing or a skin rash and use that as a way to further engage patients in the encounter. Weaknesses for me are the more complex tasks: doing searches during the encounter, generating referral letters, and determining which data to include in a way that will be most useful to the consultant.

Now a question for readers of this blog...

What is the secret in becoming an effective user of an EMR and how long does it take before the system no longer gets in the way of the patient encounter? What do you feel were the major barriers or are still barriers to use of an EMR during the patient encounter? Finally, if there were any advice you could give colleagues on how to reduce the barriers created by your EMR, please share your tips and pearls.

To add your thoughts and feedback, click on the “Comments” link below.

How to Successfully Select, Implement and Use an EMR in your Medical Practice

What do you need to know in order to be successful with your EMR? These questions and other key insights collected through hundreds of discussions with physicians, practice managers and technology experts are summarized in a presentation at Family Medicine Forum - October 15, 2010

 
If you would like to add your thoughts or comments, click on the 'Comments' link below

'Best Practice' Workflows for Processes in the Medical Office

The following was submitted by a regular reader of CanadianEMR:

I am wondering if it might be possible to post a question on your site asking whether any doctors/practices have documented “best practice” workflows for their offices for various business processes?

These include:

• Rostering a new patient;
• Scheduling:
• Registeration/checkin;
• Documenting/maintaining history;
  
• Ordering diagnostics:
• Prescribing;
• Referring;
• Scanning, etc.
  

I thought this could be a good way to see if there are any sources out there.

Have you had any experience developing workflow processes in the office to manage these tasks? Do you have any best practice tips or lessons to share with readers of this blog? Add your thoughts by clicking on the 'Comments' link below.

Developing a Standardized Format for Consultation Reports

Any user of an EMR system will confirm that a significant amount of time is spent reading consultation reports that arrive in paper format and are then scanned into the EMR. Usually these are scanned as image files, TIFF or Adobe .pdf format. Less frequently the documents are scanned and converted into searchable text using OCR (optical character recognition) software. Either way, the purpose of this posting is not to debate the relevative merits of how documents should be scanned, it is really to point out that in the electronic (EMR) world, it makes a significant difference in terms of how the document is formatted at the time of creation.

A typical consultation report in a paper format, comprises an introduction with a review of reason(s) for consultation, the findings on history and examination, a summary of findings and recommendations. The summary and recommendations are usually on the last page of the consultation report. Many busy family physicians will turn initially to the last page to read the summary and recommendations and if more detail is required, will read the important sections in the document. Some reports can be as long as 10 pages. In a paper world, it is easy to flip to the last page for the 'quick view'. This is human nature. What was found, what needs to be done?

In a scanned format, this is not as easy. Often it requires opening the document in a viewer - e.g. Adobe Acrobat. Then, in order to do what has been habit for many years, one needs to drag the slider bar to the last page in order to review the summary and recommendations. It does not take rocket science to realize that this is quite inefficient and time consuming.

So here is my plug for a standardized format for consult letters in an electronic world. The summary and recommendations should (as a standard default) be printed on the first page, with all other details following including the history examination and findings. This would make it much easier to review documents that need to be opened in a viewer without the need for onerous scrolling. One of my specialist colleagues uses this format and it works extremely well.

Any thoughts on this type of approach? Is it worth pursuing as a recommended formatting standard for reports that are to be scanned? To add your comments, click on the 'Comments' link below.

Transfer of data from one EMR to another

One of the key questions facing purchasers of EMR systems is that of transferability of data. A significant cost in the implementation of an EMR is the time that is utilized to enter data into the system. Medication lists, immunization histories, allergies, clinical encounters etc.

So, what happens if the EMR that you have selected is no longer supported in the future, or you join a group that uses a different EMR system? How do you get your data from the current system to the new system? Obviously standards play an extremely important role in this situation. If all community EMR systems were built using the same standards for data collection, this would not be an issue.

It is extremely important that this potential situation be discussed with your vendor when selecting an EMR system and that a mechanism to transfer data be agreed upon in the event that you should have to change systems.

If you have had experience using an EMR system in Canada and have needed to move your data, share your experience by clicking on the comments link.

Tips for New Users of EMRs

Do you have any tips or suggestions for new users of EMR systems. Share your experience with other users. Click on the 'Comments' link below this posting and type your tip(s) into the text box.