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

Data Portability Between EMR Systems

Reported in Technology for Doctors, May 26, 2011, by Rosie Lombardi, OntarioMD has developed data portability requirements for transfer of information between different EMR systems. Eleven EMR vendors in Ontario are certified in Ontario under the version 3 specifications.

However, there are some challenges to transferring data between EMRs that have nothing to do with the technical specifications.

One issue is that doctors often don’t use fields for the purposes they were intended. “They might put in different things in a field designated for lab tests as a workaround. Doctors use EMRs differently. We’ve run into weird problems, like someone cut and paste text from the Web into a comments field, which confuses the system.”

Another issue is that most EMR systems have been set up for text data rather than coded data based on standardized medical terminology such as SNOMED. “We often run into problems when doctors migrate from older EMR versions built on previous specs. The edits on fields were not strong in these legacy systems if doctors didn’t put in the data correctly.”

These are not simple issues to resolve; however, data portability is a critical issue that has to be resolved.

It is also not just about transfer of information between EMR systems for the purposes of migrating from one EMR to another. Patients are mobile and there is always some churn and movement between different practices. Unless there is a mechanism to transfer an electronic patient record from one practice to another, the only options are to print a copy of the electronic chart, which is then sent to the new practice to be scanned or manually entered into the EMR, or to export the record as a .pdf document. The UK dealt with the transfer issue by creating GP2GP, however this is dependent on data being stored in the same standard format.

Earlier this week I had an opportunity to spend some time with a colleague from Denmark. Transfer of clinical information is completely electronic in Denmark, with the ability to send referrals and consultation reports electronically and E-Prescribe directly to the pharmacy. In order to test the structure of the data that is transferred from one EMR system to another, the Danes have set up a test whereby the data is transferred consectively between every certified EMR to confirm that when it reaches the last EMR system, the data is still readable.

What are your thoughts on the importance of data portability between EMR systems? How should we deal with data portability in Canada?

Click on the “Comments” link below.

Convergence of IT and Health Technologies Symposium on March 31 2011

For those who are more technically minded, BCIT is holding a free one-day symposium in Burnaby on March 31, 2011. Designed to bring together small- and medium-sized companies in the medical device and eHealth industries from BC to learn about convergence in IT and medical devices, discuss implications, and identify opportunities for information sharing and industry support. Speaker presentations and a facilitated roundtable discussion among participants.

Details:
Time: 9:00 a.m. to 4:00 p.m. (registration starting at 8:30 a.m.)
Location: British Columbia Institute of Technology, 3700 Willingdon Ave, Burnaby, British Columbia
Cost: Free (pre-registration is required)

Speakers:

• Medical Devices Bureau, Health Canada — Sarah Chandler
• Information Technology Association of Canada (ITAC) — Brendan Seaton
• Customer and End-User Perspectives 
BCIT Technology & Product Evaluation Group – Johanne Mattie 
BCIT
• Product & Process Applied Research Team — Nancy Paris
• NRC Industrial Research Assistance Program (IRAP) — Rizwan Kheraj
• Digital Media and Wireless Association of BC (DigiBC) — Michael Bidu
• Facilitated Roundtable Discussion — All Participants

Click here for more information and to register

Dana Higgins
Event Coordinator
Applied Research Liaison Office
dana_higgins@bcit.ca

Request for Assistance from a Physician in Ontario - Reminders and Notifications

The following request has been submitted by Dr. Mark Quigg in Collingwood, Ontario.

In Collingwood and area we have a linked EMR with 37 MD's and have programmed our computer for the usual automatic reminders. We would like to take things a step further and exploit the power of our EMR to remind MD's to do routine bloodwork for medication that we are all supposed to do but sometimes unfortunately forget (eg CBC and Liver Function Tests every 6 months etc. on an anti-convuslant, routine blood sugar and cholesterol for patients on Zyprexa, Risperdal etc).

We have already developed one for Amiodarone and would like to expand things to the psychiatric/anticonvulsant drugs. At the same time we don't want to "reinvent the wheel" and were thinking some other group of MD's /EMR must have done all this already and probably done it even more comprehensively than we were going to or could.

Do you have any idea how we would contact someone who has already done this before? 

Add your thoughts and suggestions by clicking on the 'Comments' link below

CBC News - Health - Electronic health records: Why Spain is getting it right

Stephen Strauss has written a number of editorials for CBC News regarding the Electronic Health Records strategy in Canada. More recently he visited the province of Andalusia in Spain and describes his impressions of the Andalusian experience with EHR/EMR. (Important to note that GPs in Andalusia all practice in clinics funded by the state and use the same EMR system). I have included a short excerpt from Stephen's article.

SEVILLE, SPAIN — There are many reasons Canadians visit Spain's olive and grape bedecked Andalusia province. To frolic and burn on the beaches of Costa del Sol. To discover the meat of the bull killed in the bull ring surprisingly tastes like venison and not beef. To be dazzled and dumbfounded by the Alhambra and the abstraction of beauty that was Moorish Spain. However, as part of a series I am writing on electronic health records I recently visited Andalusia to see an entirely 21st century amazement — an electronic health record system that doctors loved, that pharmacists loved, that hospitals loved, that patients loved, and that seemingly saved everyone time and money. That is, to see an EHR system which absolutely exists nowhere in this country.

Doctors keeping drug costs down I have to stifle a gulp. All the doctors in Andalusia see as they are prescribing the cost implications of their actions. The system doesn't require them to only prescribe generics; there can be legitimate reasons a brand name drug is better. But if they do prescribe one, they have to explain the reason why they are doing it in the electronic record.

Click here to read the full article - CBC News - Health - Electronic health records: Why Spain is getting it right

Add your thoughts or comments, by clicking on the 'Comments' link

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

To add comments or feedback, click 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.

Podcast: The Benefits of Primary Health Care Teams. An Interview with the CEO of the Health Council of Canada

In many provinces across Canada, the development of Primary Health Care Teams have been a significant part of provincial primary care reform strategies. Recently, the Health Council of Canada released a report entitled, “Teams in Action: Primary Health Care Teams for Canadians”. As the Canadian healthcare system struggles with an aging population and the growing prevalence of chronic disease, the issue of collaborative care is becoming more critical. How do we deal with these challenges and what is the role of collaborative care and a team-based approach? My guest is John Abbot, CEO of the Health Council of Canada.

Listen to the Podcast:

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

Chronic Disease Management - Challenges in Using Data if not in the EMR

The following comment was submitted by Dave Sellers and is posted on his behalf.

"We have created a Diabetic Registry in our clinic using the EMR data. It comes out in the form of a Spreadsheet 61 columns wide. One row for each patient (553 for us). We have found, patients that should not have been diagnosed with diabetes, some that have been missed, controlled, uncontrolled, sometimes controlled and more.

One thing that we now understand, we need to take snapshots of this data and store them. Then compare past static data snapshots to current to see how we are doing. Since a patient's data is dynamic and conditions change over time (age of patient), it is very difficult to "analyse" large quantities of patient data. (I understand we need a PhD level resource to do this).

Since the data in the EMR is constantly changing, we don't see the value of the central data registry that some organizations are promoting. If you don't have an EMR, you will never have the time to input the vast quantities of data needed and keep it up-to-date. We are working on some prototype tools to assist the physician with CD risk analysis while meeting with the patient, but again, this is very difficult to do when so many data elements are required."

Dave Sellers
Director of Operations
West Carleton Family Health Team

Here is another article (The Medical Post) that describes work being done by GPs relating to delivery of care for Chronic Diseases.

"While much has been made about the slow rate of primary-care reform in the country, Canadian family doctors are, quietly and at the grassroots level, making changes to their practices that bode well for a vast improvement in chronic-care outcomes....

One of the reasons why Canada is a primary-care laggard is due to the poor uptake in health information technology, observed the doctors interviewed for this story.

While doctors can perform patient-care quality improvement exercises using paper records, that method is more onerous, said Dr. David Price, chairman of McMaster University’s department of family medicine in Hamilton.

“If you are going to be doing quality (improvement) work, you really need to have an electronic medical record to identify your patient population and to collect the proper indicators. To do that in a paper environment would be very intensive,” he said."

A great deal of work is happening nationally in the area of Chronic Disease. If you have experienced success or specific challenges in a project or in a program for the treatment of patients with chronic disease, please share your thoughts or comments by clicking on the 'Comments' link below.

Are Social Networking Sites useful to Physicians?

According to marketing web site ClickZ, findings from a new Manhattan Research report demonstrate significant interest from doctors in the US to use social networking sites.

By Virginia Citrano, ClickZ, Jan 27, 2009: Some 60 percent of doctors in the United States use social networking sites for physicians, or are interested in joining them, and they write more prescriptions than medical colleagues who are not active in such sites. These are among the findings in a new report from Manhattan Research, a New York-based pharmaceutical and healthcare market research company.

According to "Taking the Pulse v8.0", which surveyed more than 1,800 doctors nationwide, physicians active in online communities tend to be primary care doctors, female and, perhaps not surprisingly, younger than average. And a statistic that should catch the attention of online video creators: 83 percent of physicians watch online videos, compared with 34 percent of all U.S. adults.

Click here to read the full article

However, what does this mean from a practical and pragmatic perspective? Are physicians going to begin using social network tools such as twitter or the newly launched Canadian Medical Association web site Asklepios? Use of Asklepois has increased since the site launched in August last year and now has about 1,300 members. One of the most active groups on Asklepios is the group relating to EMRs (of which I am a member).

It is not yet clear how physicians will use social networking tools to keep up with their colleagues and practice commitments. At this time, it appears to be more about social support peripheral to the practice of medicine.

What your thoughts? Do you see social networking tools becoming more popular? How will they be used most effectively? Do you belong to any other forms of social networks?

Take a look at my twitter profile to see how it is being used as a social networking tool.

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

Physician Stress - Schedule and On-Call Management

On of the most stressful elements of medical practice is related to schedule and on-call management. Many physicians (specialist and GP) have multiple commitments and schedules including group call lists, ER schedules, obstetrics, surgical assists and other on-call services. Being available and contactable is mission critical and creates a high level of stress for physicians, particularly as many of these schedules are managed manually using paper. If a call is traded (which happens very frequently), the paper document has to be updated and shared with all in the call group including the emergency departments at local hospitals, paging services etc. This results in a high risk of error and the net result is sometimes not being able to identify or contact a doctor on call.

A Canadian physician has developed a solution to this challenge and his company's software is used across Canada.

Listen to the December 2008 podcast with Dr. Rob Horvath, founder of Rosterware.

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