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

Stories of Success - HIMSS | ASQ

A series of hospital-based case-studies has been published in the US by HIMSS and co-sponsor American Society for Quality (ASQ). 16 submissions were selected. The initial 6 have been published and the remainder will be availble in late February - Read the details: HIMSS - ASQ Stories of Success.

Shopping for Health Software, Some Doctors Get Buyer’s Remorse

In a January 29, 2010 Huffington Post Investigative Fund Report, reporter Emma Schwartz points out some of the dark side of computerizing medical offices.

Computerizing American medical records within five years is a key goal of federal health policymakers, who have committed to dispense billions of dollars in stimulus money to doctors and hospitals that make the transition in the coming years.There are numerous examples [quoted in the article] of what can go wrong during a move to digital systems, highlighting some of the challenges for individual medical practices making the conversion.

The Bush administration first set the goal of putting most Americans’ medical records online by 2015. By 2006, the industry had begun to receive some oversight through the Certification Commission for Healthcare Information Technology (CCHIT), a nonprofit organization contracted by the government to certify electronic health records. The commission reviews whether companies’ products meet the operating standards they promise. It does not evaluate the firms’ financial viability, although since 2008 it has asked companies to voluntarily disclose their number of customers and how long they have been in business.

Mark Leavitt, chair of the certification commission, said evaluating the financial stability of a company poses many challenges. For example, he noted, even a big, financially successful company could decide to discontinue a software system that didn’t pan out. And merely certifying the firm’s financial strength could give doctors “a very misleading sense of security” about the future of the product they bought, he said.

Shopping for Health Software, Some Doctors Get Buyer’s Remorse | The Huffington Post Investigative Fund.

As the EMR industry matures in the US and Canada, consolidation will take place. Despite best efforts at predicting the winners and the losers, there will almost certainly be some margin for error. As Mark Leavitt states, evaluating the financial stability of a company poses many challenges. The sense of security associated with vendors being selected as a provincially certified EMR systems in Canada also provides no guarantee that these product will be available indefinitely as a result of dynamic changes shifts in the market.

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

Top 10 Benefits of Medical Practice Automation

I was recently asked for my opinion regarding the Top 10 benefits of medical practice automation - i.e. implementing an EMR. If one does a Google search, there are hundreds are articles on this subject and some variances in opinion. Having discussed this with colleagues, EMR program managers and individuals with experience in using EMRs, here is my Top 10 list. Please add your thoughts or comments if I have missed a key benefit or you would simply like to contribute to the discussion.

Top 10 Benefits of Office Automation

1. Integration and aggregation of information: The ability to move between different elements in a patient encounter very quickly. E.g. review last result, review last visit, review patient CDM data;
2. Readiness and organization of information: The ability to quickly manage a large number of data points and effectively use them for patient care;
3. Administration: The ability to eliminate the task of creating and managing paper charts. No chart pulls or re-files. No misplaced or duplicate charts;
4. Error reduction: The assurance that all clinical information is in the record;
5. Follow up care: Effective patient follow up regarding results, consultations, investigations;
6. Improved use of resources: Space savings as paper records do not require storage, people can be more effectively utilized for different tasks, time-savings due to rapid access to information;
7. Reduction of duplication: The ability to quickly review lab results or investigations and reduce duplication or the ordering of inappropriate investigations;
8. Chronic Disease decision support: The ability to be proactive in patient care for chronic disease management. E.g. Practice audits for large groups of patients with the ability to easily drill down to the individual patient level;
9. Medication decision support: The ability to prescribe electronically with automated decision support (Drug:Drug, Drug:Disease, Drug:Age interaction warnings and alerts);
10. Remote access: The ability to remotely access patient records from home or alternate locations such as a separate clinic or hospital.

Do you agree or disagree with this list? Add your thoughts or comments, by clicking on the 'Comments' link below

How Long Does it Take to Develop a Great EMR?

I have been monitoring and watching the EMR market for the past 15 years and over that time I have developed a sense of what it takes to develop a great EMR system. These are my personal opinions and I would be interested in your thoughts if you are either a user of an EMR, a physician who has developed their own EMR or a vendor of an EMR product.

Developing an EMR is not simply about the technology - in my opinion, that is the easier part of the process. Here is my short list of what is required to develop a great EMR system:

• Core universally accepted standards that provide a dependable foundation upon which to develop the EMR. These core standards must be backwards compatible if they evolve over time. (This is akin to building a railway train and knowing exactly the gauge of the tracks, allowable physical dimensions and weight restrictions);
• A set of functional requirements that match the needs of the users. This requires a very clear understanding of the business and clinical processes that the EMR must accommodate. For example, if the daily work pattern of a GP entails writing prescriptions, exchanging information with colleagues, capturing clinical notes, receiving and requesting lab investigations (to name a few), then the system must be able to incorporate all of these functions;
• An ability to evolve the EMR system over time with a robust process for user feedback and product enhancement. It is my view that developing a highly usable EMR requires multiple cycles of feedback and enhancement before usability is slick enough to meet the needs of the majority of physicians. How many cycles of feedback does this take per feature - I am not sure, so would appreciate your feedback, but I think it is many!
• A stable development team. Architecting an EMR is a long-term process. If the technical platform upon which the EMR is based does not have the benefit of core developers who maintain the vision and integrity of the design, then overall stability and sustainability of the EMR can be severely compromised;
• The right value proposition: If the value proposition is not clear to the end-user, such as: Increased revenue/savings, the ability to work remotely, better information about patients, improved workflow processes, easier and more complete report generation and improved decision making, they will not adopt and use the systems;
• An acceptance that the EMR is not going to be perfect out-of-the-gate. The establishment of reasonable user expectations is key. However, the system should encompass the fundamental business needs from day one. (If you were a small business owner and a sales representative was trying to sell you a point-of-sale cash register that allowed you to make change, but required you to write the transactions down manually on a roll of paper - would you buy it? I doubt it.)

Do you agree or disagree with the list above? What are the other key requirements? To add your thoughts or suggestions, click on the 'Comments' link below.

A Doc Warns of ‘Magical Thinking’ on Health IT

Healthcare IT and EMRs tend to be viewed by many as a magic bullet - something that can be thrown into the healthcare setting that will resolve many of the problems we currently face. This is an interesting blog posting from the Wall Street Journal Health Blog and has some thoughtful comments.

“There’s this incredible magical thinking about health-care IT,” Jack Cochran said. “Once you put it in, health care will be saved.” Cochran is an M.D. who runs the national umbrella organization for groups of Kaiser docs, and he was a practicing plastic surgeon for years, so he’s seen his fair share of health-care IT implementations. The subject came up this week when he dropped by the Health Blog’s office. “It is a disruptive technology,” he said. “When you put it in, it slows you down.” A Doc Warns of ‘Magical Thinking’ on Health IT - Health Blog - WSJ.

It is logical that IT will be disruptive and will slow you down when implemented, however this is not always the case and many physicians experience an improvement in productivity in specific areas after the initial bugs have been worked out.

Have you experienced a slow-down with your EMR? When did you return to normal productivity levels? Have you increased your speed beyond the time that you worked with paper records?

Add your comments by clicking on the 'Comments' link below.

The eHealth Scandals - Do your Patients Care?

One cannot help picking up a newspaper or visiting a news web site these days without reading an article about a provincial or national eHealth scandal. The trials and tribulations of eHealth Ontario and their $1 Billion boondoggle, the ongoing investigation into the eHealth program in BC, the firing of a London Health Sciences Vice President in charge of an eHealth program and today the announcement of the Canada Health Infoway Auditor General's report on that organization's performance after having received $1.6 Billion in funding.

In the online media this is a very hot topic. Almost every article is accompanied by an enraged public with the vast majority of comments targeted negatively against the various programs and historical occurrences. And some of the comments are pretty biting.

The majority of the outrage has been targeted at large systems that are being developed at the regional or provincial levels.

Well, what about the GPs and Specialists who are seeing the 80% of patients daily in their offices and providing care? Those physicians who have adopted EMRs and embraced the change are generally very happy with the new capability and functionality they have achieved. Most do not have to deal with the larger public system other than to receive lab results or in some cases discharge summary or diagnostic reports (which all have to be delivered to them under law either in paper or electronic format for their own patients).

So, does the general public care about eHealth or have any interest in the current scandals that are so prevalent in the papers?

What are your patients saying about eHealth when they see you in your practice? Do they mention it? Is it an item of interest or concern? Is the whole issue being blown out of proportion by the media? With H1N1 as such a topical healthcare issue, where you think eHealth sits in level of priority in grander scale of things?

Please take a couple to minutes add your feedback regarding what you are hearing from patients. This will certainly be insightful in light of the ongoing public debate.

Training - Essential to EHR/EMR Success

Health Data Management - September 18, 2009: A key strategy for successfully rolling out an electronic health record at a group practice is providing custom training for users with different technology skills and personalities, the CEO of a practice with 235 physicians says. Guthrie Clinic in Sayre, Pa., divided doctors into 11 groups for training purposes, says Joseph Scopelliti, M.D. president and CEO. For example, he jokes, some were labeled as “tech-savvy but grumpy” while others were “easy-going but uniformed.” Then the practice developed 11 targeted training programs to meet doctors’ specific needs.

Read the full article: Training Essential to EHR Success

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

Barriers to EMR Adoption - The Value of a Medical Practice

Ask any primary care physician who has recently retired how much they were able to sell their practice for and you will receive a quizzical look and the following response, "Sell my practice? Hah! Don't know a physician who has been able to sell any practice in my community for years. I know about a couple of walk-in-clinics that were sold a few years ago, but no GP practices, in fact I could not even give my practice away." And that's the truth of the matter. It is not possible to sell a family practice even at the end of an illustrious career, years of service to the community and a stable and well managed group of patients that can number in the thousands.

It was hard enough convincing physicians that there was an incremental value to be achieved by investing in one's practice even in days when practices had a resale value. These days, with a zero (or possibly negative value) at the end of 40 years of medical practice, encouraging physicians to 'invest' in their practices without the ability to recoup or see additional value from that investment is a tough sell.

If it were only the business case relating to the resale value of a medical practice that was the primary driver in getting physicians to adopt EMRs, we would be further behind in Canada than we are right now.

You might ask how there could be a 'negative' value to a medical practice at the time of retirement. The answer is simple. Physicians are governed by rules established by the provincial licensing authority (College of Physicians and Surgeons). It is the responsibility of the retiring physician to notify the College in their particular jurisdiction where the medical records have been stored following closure of their practice and to forward patient records upon request to a physician who has assumed care at the request of that patient. A fee can be charged for the records transfer, but the fact of the matter is that unless the physician contracts chart storage and requests for transfer to a 3rd party service such as DocuDavit Solutions (an Ontario-based company), that physician would be personally responsible to retrieve and transfer each record upon request. Not really a glowing picture of retirement. Not only has the retired physician not been able to sell or give away their practice, but they are on the hook for chart storage and responding to requests for transfer for at least 7 years for their adult patient records and indefinitely for records of children under the age of majority at the time of closure of their practice.

How do EMRs change this equation? Well, if the physician had the foresight to implement an EMR prior to retirement, it is more likely that he or she may have been able to attract a young tech savvy physician to take over the practice as it is EMR based. In addition, the records should be convertible into a format that can be stored on one or more DVDs and made available upon request by burning a disc and sending it to the requesting physician. Definitely more attractive than the paper scenario.

The fundamental problem is still that it is not possible to sell a medical practice and recoup years of investment and ensure continuity of patient care. Contrast that with a recent taxi-ride that I took in Vancouver. The driver informed me he was lucky enough to have been able to purchase a half share in the taxi for the princely sum of $200,000.

You have to admit, there is something wrong with this picture...

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

Incorporating Faxes Directly into an EMR

A frequent difficulty encountered by users of EMR systems is the management of incoming documents such as diagnostic reports or consult letters. Traditionally these documents are received via regular mail or fax in paper format. EMRs generally manage paper through integrated scanning applications. A popular series of scanners is the Fujitsu ScanSnap. To read more about scanning documents into an EMR, read the posting Have you been forced into running a scanning sweatshop?

However, this does not solve the problem of how to incorporate documents received electronically via fax into an EMR.

The following question was submitted by Dr. Chris Outram, a family physician in British Columbia:

"Does anyone have any experience with fax software that integrates well with the emr environment? I am working with med-access and finding that it is:

1. Cumbersome to incorporate incoming faxes, and
2. The fax software that I have used so far (snappy fax and US robotics software that came with the modem) has not been all that reliable or highly functional.

Your advice would be much appreciated."

Are there any best practices in terms of high performing fax modems that can be installed in an office computer to receive incoming faxes? Is there fax software that outperforms the snappy fax or US robotics mentioned above by Dr. Chris Outram? Do users of med-access have tips/tricks or recommendations for Dr. Outram to help him more effectively integrate faxes?

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

Choosing an EMR Vendor

In an article published in the March 2009 BC Medical Journal, Jeremy Smith, Program Director for the Physician Information Technology Office provides an overview of the selection process that physicians should consider when choosing an EMR. An excerpt from the article is published below:

“Ask for a large selection of names (clients), as vendors may only supply names of a couple of infatuated users,” recommends Dr van Wyk. The choice of an EMR vendor will deeply affect your office’s daily routine and the delivery of patient care. Switching to an EMR affects almost everyone connected to your practice. Comments Dr van Wyk, “It’s essential to distinguish between what vendors can reasonably do for you and what they cannot. Vendors are not well equipped (nor can they be expected to be) to deal with the inevitable transitional stresses that both staff and practitioners experience during the implementation phase.”

Read the full article

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