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

How did New Zealand achieve 100% EMR Adoption in Primary Care?

New Zealand (as with Denmark) is an example of a country that has achieved an extremely high level of EMR adoption by GPs and a level of adoption by specialists that is not far from 100%. How did they do it? What are the secrets and lessons learned? What was the history of EMR adoption in New Zealand? What is seen in retrospect as the critical factors that have allowed New Zealand to achieve current levels of adoption?

Tom Bowden, Chief Executive for HealthLINK, an organization in New Zealand that automates and standardizes the exchange of medical information between electronic systems shares his experiences with EMR adoption.

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Governement Health IT: The Missing Pieces in 'Meaningful Use'

As part of the US Health IT build out process, work is being done to define Meaningful Use. However is it complete? Dr. John Loonsk, the former director of interoperability and standards in the Office of the National Coordinator for Health IT argues that "several pieces are still missing" from the Health IT Policy Committee's initial definition of "meaningful use" of electronic health records.

While approaches now exist for allowing systems to work together (standards), and for testing systems to establish that they can work together (certification), and while funding exists for electronic medical records, none of these ensure that the people and organizations involved in health will actually make the systems work together to exchange information and support improved healthcare quality, access, efficiency and public health. As currently conceived, “meaningful use” will also not change the misaligned incentives that have been so problematic. Comment: The missing pieces in meaningful use -- Government Health IT

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CanadianEMR Featured - MITACS ACCELERATE

Through the Networks of Centres of Excellence (NCE) program, MITACS funds mathematical sciences research projects throughout the country. One of these sectors is biomedical and health.

During 2008, CanadianEMR had the opportunity to receive MITACS support through a graduate and post-doctoral internship program called MITACS ACCELERATE, This program offers students the opportunity to apply their research to real-world issues.

The project was designed to measure the Impact of EMRs on Wait Times, System Productivity and GP's Ability to Accept New Patients

This valuable work helped further our understanding of the impact of EMRs on physicians and healthcare system and provider capacity.

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CMPA: Legal Risks of Using Email to Communicate with Patients

The Canadian Medical Protective Association has published an Information Sheet for Canadian physicians regarding the use of email to communicate with patients listing in detail the legal risks from the perspective of confidentiality, privacy and security, the timeliness of responses and the clarity of communication. In addition, the CMPA has provided a very useful template consent form that can be copied and used by physicians to ensure that patients understand the risks and responsibilities if email is used as a communication medium.

Download the Information Sheet and Consent Form (.pdf) [pages 5~8]

CMPA: The bottom line

• Members should understand the legal risks associated with email communication with patients.
  
• Before engaging in email communication, members should review any applicable statutory and/or College requirements that may impact the use of email for transmitting patient health information.
  
• Patients should also be aware of the potential risks and agree to assume those risks. A signed consent form that outlines the risks of email communication, as well as the obligations placed on those patients who wish to correspond via email, provides a permanent record of the consent given.
  
• Members working within an organization should be aware of the risk of access by the organization to any email communications, including those sent to patients and third parties, using an organization’s computer system. This caution is especially pertinent for members who are being assisted by counsel with a legal matter.
  
• Members should establish policies and procedures for the handling of email communications. Employees should be informed (through a policy or otherwise) of the risks associated with inappropriate email communication.

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Podcast: Achieving EMR Interoperability - A Discussion of the BCMA Position Statement

June 2009: A BCMA document entitled 'Achieving Interoperability in the EMR Context', has just been published.

BCMA Position: Interoperability - the ability of two or more information systems or components to exchange information and use it reliably and rapidly without error - is a critical priority for EMR systems in order to provide safe, effective support for health professionals providing care. The Ministry of Health Services (MOHS) and Health Authorities must make interoperability of health information systems a priority.

• Less costly “viewer-only” solutions currently favoured by government cannot substitute for fully-interoperable health information systems. These systems will become rapidly obsolete as more physicians adopt electronic medical records (EMRs) and require interoperability.
  

The MOHS must implement by 2010 a provincial identity management strategy integrated with health information systems at the point of care (i.e., in the physician’s office at the time of the interaction with the patient) as a prerequisite to the effective interoperability of health information systems.
Download from the BCMA web site by clicking on this link (.pdf format).

Dr. Alexandra Tcheremenska, Associate CEO for the BC Medical association is interviewed regarding the Position Statement.

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Report Published - Physicians & Technology: The Frontline Perspective

How do organizations cope with an EMR enabled physician workforce? What are the challenges facing physician practices, hospitals and community care services as physicians become sophisticated users of technology including EMRs? To answer these questions, CanadianEMR has launched the first in a series of reports aimed at providing current insight into the rapidly changing Electronic Medical Record environment in Canada. The first report focuses on national and regional market trends that are impacting how physicians adopt and use EMR software. Each report combines current information on EMRs in combination with a theme that relates to care delivery. In the first report, we focus on the use of Information Technology and EMRs in relation to Chronic Disease Management. Future reports will focus on Telehealth, Privacy of Confidential Patient Information and Provincial EMR Certification programs.

For a limited time, receive a 10% discount when you purchase the report through the e-store by using the eHealth2009 discount code. Click here to learn more

Chair of the eHealth Ontario Board Resigns | Legislation gone Wild in the US

Ottawa Citizen: Dr. Alan Hudson resigned Wednesday as chairman of eHealth Ontario, the provincial agency that became an embarrassment to Premier Dalton McGuinty when it was revealed workers had taken advantage of lax hiring rules to award bloated contracts to consultants, some of whom nickelled and dimed the pubic by expensing such items as cups of coffee and chocolate chip cookies. Click here to read the article

FierceEMR: A bill pending in the New Jersey legislature would outlaw the use of health IT products not certified by the Certification Commission for Healthcare Information Technology. Anyone caught selling or distributing a non-certified product would be subject to civil penalties of up to $5,000 per violation. This goes far beyond anything in the federal stimulus legislation known as the American Recovery and Reinvestment Act. The federal law contains financial incentives for using certified EMRs, and eventually penalizes healthcare providers who don't ditch the paper charts, but it only applies to Medicare and Medicaid billing. The New Jersey proposal, from Democratic Assemblymen Herb Conaway Jr.--a physician--and Upendra J. Chivukula, would hit doctors and hospitals that don't see a lot of Medicare patients. Click here to read the article

While these two stories are unrelated, they do represent opposite extremes. On the one hand, an apparent lack of process in the management of a large provincial program and on the other an attempt to micro-manage a state program to the point of applying civil penalties should a company sell, distribute (or even give-away) a non CCHIT certified EMR. Read the bill

I am pleased that I do not live in New Jersey (should this particular bill pass). I am also saddened by the activities taking place in Ontario. We have moved beyond the stage of EMRs and EHRs being a good political story, we now have to make them work. This is the grinding, unpleasant and difficult trough of disillusionment in which we find ourselves. In the end, we are partly down a pathway towards an IT-based healthcare system. We must keep this process moving forward no matter how painful or unpleasant. It is a matter of necessity and national pride. The alternative is to be overtaken by third world countries who will one day be able to say that (unlike Canada) their healthcare system is fully electronic.

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Defining Meaningful Use - Preliminary Matrix for the US EMR Strategy

As the US develops a comprehensive strategy in order to define meaningful use for EMR systems, a number of documents and discussions have been posted on the Health Information and Technology web site - http://tinyurl.com/orh34l.

There are no big surprises in terms of the types of information that will be expected to be captured and reported relating to the meaningful use matrix (Download PDF), however one of the criteria for 2011 which is intended to improve care coordination involves the "Implemented ability to  exchange health information with external clinical entity (specifically labs, care  summary and medication lists)". This is a challenging requirement for fully implemented EMR systems due to the need to inter-operate and share information with external systems such as labs and pharmacies.

What are your thoughts? Can the US successfully achieve these types of objectives?

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Future of Electronic Medical Records

The US is moving progressively towards EMR and EHR. As we have learned in Canada, this is a complex journey requiring a focus on people, process and technology. However the commitment in the US is palpable with $17 Billion beginning to flow in 2011.

A poignant statement is the fact that the hospital featured collects 'all' medical information on the patient for their entire healthcare experience in electronic format. Not half or just labs and medication information -  everything! No double tasking, no need to track certain information in paper and other information in the EHR. This is critical - the benefit is greatest when a process is fully electronic. Will the US reach their 2015 target of all patients with Electronic Medical Records? I think these targets are extremely aggressive and likely not achievable. But the US will significantly raise the bar. Expect lots of creative thinking.

Given the eHealth Ontario fiasco and the slowdown that is likely in Canada across the country, what might we be doing in 2015? I hope it is not still debating what information should be going through the HIAL (Health Information Access Layer).

Come on everyone - we need creative and innovative thinking.

Three years ago I attended the yearly eHealth conference in Victoria. At the conference, I met a physician from Africa who was based in Paris and working on behalf of three countries to implement an Electronic Health Record for the three nations. When I asked him whether he was at eHealth to find technologies to take back to his project in Africa, he looked at me with surprise. "We already have an Electronic Health Record," he commented, "It's an open source product and is used by all the care providers in the system and it is used in three countries." There's a lesson to be learned here.

Let's focus on the patient journey, make sure that we are asking the right questions, clearly map out the use cases and workflows for all users of the system and more than all of the above, think creatively. Meaning tactically and strategically - in order to keep the process moving.

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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.

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The Galapagos - A Short Break to Recharge the Batteries

Working in healthcare informatics is extremely busy (exciting and laced with new challenges), but tiring none the less.

From May 22nd to June 1st, I had an opportunity to visit the Galapagos Islands along with 92 other physicians and friends on a Sea Courses Education Cruise that took place on the Celebrity Xpedition. Arriving in Quito, Ecuador and then visiting islands such as North Seymour, San Cristobal, Espanaloa, Santa Cruz and Bartolome.

This was a welcome break and a remarkable experience that I would highly recommend.

I have included a selection of photos taken in the Galapagos. (All photos are taken with a Nikon D700 camera). Click on any image to see a larger version.

It's all about 'Information Exchange'!

For the last 10 years, I have been increasingly focused on understanding information technology and Electronic Medical Records from a general system perspective, but more specifically from the user side - physicians, medical office staff and ancillary providers. There have been varied approaches to encouraging EMR adoption from country to country. In some cases focusing purely on information and messaging exchange and in others (such as Canada and now the United States), establishing a wide range of requirements to which EMR vendors have to conform in order to sell their products at either the national or provincial level.

In countries that have taken a pure messaging exchange approach (Denmark and New Zealand), they have achieved rapid and widespread adoption of EMRs. In countries that have taken a more prescriptive approach to defining EMR requirements regarding a wide range of features beyond the area of pure information exchange, uptake has been limited and in some cases slowed by long periods of limited activity as vendors build out their EMR products to reach conformance with national or jurisdictional standards and requirements.

Some countries have focused more specifically on health performance metrics reporting and linked these measures directly to reimbursement (such as UK). Also an effective strategy to encourage adoption of EMRs - but still leaving large gaps in terms of system interoperability with other vendors (including labs and hospital systems).

In no country has there been a concerted effort to understand human factors and usability, although in the UK, Microsoft has done work on a Common User Interface (CUI) to define standard presentations for data such as a Medication List.

If one had to compare different national approaches to encouraging EMR adoption by physicians, it is my belief that the messaging exchange approach wins hands down over other approaches. It is important to note that these various approaches are not mutually exclusive, however the greatest value of an EMR (or any other healthcare information system) is the ability to efficiently and accurately facilitate information exchange between providers in the healthcare system. Any strategy that does not identify information exchange as a core fundamental capability will be faced with limited success.

I rest my case. Unless many different kinds of messages (including referral requests, consultation reports, prescriptions, diagnostic imaging and laboratory reports and requisitions etc.) can be easily exchanged between all necessary points in the healthcare system, there will not be sufficient value for a healthcare provider to adopt and use an EMR system as their primary tool to deliver care. They will be forced to double-task as they have to juggle between electronic and paper processes and they struggle to cope in an increasingly complex healthcare system.

Come on folks, we don't have much time to mess around. We need to learn from countries that have done messaging well (Denmark and New Zealand) and integrate their approaches to accelerate adoption of EMRs. There are bigger challenges at hand - we need to focus on healthcare delivery and we are going to cope with an aging population of patients with chronic disease.

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eHealth Ontario - Chiefs gave $2M Deals to Associates

Controversy continues to grow regarding eHealth Ontario with respect to contracts awarded to the Courtyard Group (a consulting company) and additional external consultants.

The Toronto Star - June 4, 2009: 'At least $2 million in untendered contracts were awarded by eHealth Ontario to long-time associates of agency chair Dr. Alan Hudson and CEO Sarah Kramer, Progressive Conservative MPPs allege. The revelations marked the first time the growing controversy surrounding the agency has involved Hudson, the former president of the University Health Network and the key figure in Ontario's push to reduce wait times.  eHealth chiefs gave $2M deals to associates'

These matters are under investigation at present by Ontario's Auditor General and it is evident that any dirty laundry will be aired. However, even more important that the underlying controversy is the impact that this uncertainty will have on strategies underway to deliver care to Canadians. eHealth Ontario is a massive undertaking that involves a virtual army of people to deliver meaningful and useful products and services. To keep these projects moving forwards requires coordination with multiple parties in the system (government, health regions [LHINS], community services, physician practices etc. Deadlines and dependencies are par for the course and when one wheel grinds to a halt, it has a devastating impact on other components.

If the ultimate decision is to replace the leadership of eHealth Ontario, the impact on the overall strategy will be significant. There are few individuals who understand the complexity of initiating and then coordinating programs of this complexity and in my opinion, the impact could bring into question the value of the entire program and whether the approximately $2Billion strategy will be able to deliver on its promise.

In the end, we have all lost as a result of this unfortunate saga. An opportunity squandered that has significant implications for eHealth as well as the health of Canadians.

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