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

Can we Achieve Healthcare System Sustainability with Fixed Budgets and Insatiable Demands?

Get used to doing more for less!

One does not have to be a rocket scientist to see that healthcare system sustainability is going to be a huge challenge for nations in the years to come. Already, demand outstrips supply in many developed countries. Approximately 50 million people do not have health insurance coverage in the US and 5 million Canadians cannot find a family doctor. These are not uncommon examples internationally of healthcare systems under pressure. Not only are these situations reflective of concomitant personal tragedy, but they also reflect the fact that unless countries get healthcare costs under control, this problem has the potential to sink the economies of great nations.

We hear terms such as 'healthcare reform', shared services strategies, automation of paper processes, but what does it mean to patients and to those providers in the trenches who are tasked with delivering the care? To name a few of the driving forces, we have:

• Aging populations
• Increasing prevalence of chronic diseases
• New and more expensive medications
• Advanced diagnostics and therapies
• Increased demand for clinical services

We exist in a world of increased expectations and fixed buckets of funding. In this situation, there are few alternatives. In addition to doing more for less, we have to improve efficiency and decrease waste. Some of these strategies need to focus on reducing duplication, reducing costly errors and reducing inappropriate investigations. In addition, becoming more targeted with how care is provided - something that is impossible in the dominantly paper world in which we function.

No matter how you slice and dice the problem - the automation of healthcare is one of the solutions. So get ready for more talk and action relating to EMRs, EHRs, PHRs, Patient portals and Mobile Health.

We do not have many viable alternatives!

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

Enterprise vs. Local EMR - What's the Significance?

Enterprise EMRs and Local EMRs are different from one another. Not necessarily with respect to their functionality which may be very similar to an EMR designed to be installed and managed in a small physician practice or even an ASP (remotely hosted) EMR that is designed for smally practice settings.

Some of the differences relate to the complexity of the software and the work required to configure the system for use by thousands of users. Other differences relate to how the data is managed in shared databases. How does one protect the privacy of confidential information when so many individuals have access to the patient record.

Listen the Podcast recorded with Dr. Allen Ausford, a family physician and previously the Chief Medical Information Officer for the Capital Health Region prior to consolidation in Alberta.

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

Roundtable Podcast on Personal Health Records and Patient Portals - Submit Questions by Dec 4th for the Expert Panel

A CanadianEMR Roundtable Podcast on Personal Health Records and Patient Portals will be recorded in early December and will be published on the CanadianEMR web site.

The panel of experts from across Canada includes:

• Ann Cavoukian, Information and Privacy Commissioner of Ontario;
• Dr. Alfi Moris Beshar, Consultant in Internal Medicine & Cardiovascular Disease and Assistant Clinical Professor of Medicine at McMaster University in Hamilton, Ontario;
• Sam Marafioti, Chief Information Officer at Sunnybrook Health Sciences Centre in Toronto;
• Dr. David Wiljer, PhD, Director of Knowledge Management and Innovation at the Princess Margaret Hospital in Toronto.

Topics for discussion include:

• Should we be taking a patient driven approach towards our national electronic health records strategy?
• Does the PHR modify the risks related to privacy protection in a positive or negative manner?
• Do patient portals work or do they create a greater administrative burden for physicians and hospitals without true benefit to the patient?
• Could greater use of PHRs and Patient Portals shift the balance of accountability in terms of how personal information is collected and used?
• Do GPs and specialists see PHRs and Patient Portals as useful tools or just another burden in an overwhelmed system?

Would you like to submit a question to the roundtable expert panel?

You have until November 4th to submit a question for the experts by clicking on the 'Comments' link below.

A CanadianEMR Roundtable Podcast on Personal Health Records and Patient Portals will be recorded in early December and will be published on the CanadianEMR web site.

The panel of experts from across Canada includes:

• Ann Cavoukian, Information and Privacy Commissioner of Ontario;
• Dr. Alfi Moris Beshar, Consultant in Internal Medicine & Cardiovascular Disease and Assistant Clinical Professor of Medicine at McMaster University in Hamilton, Ontario;
• Sam Marafioti, Chief Information Officer at Sunnybrook Health Sciences Centre in Toronto;
• Dr. David Wiljer, PhD, Director of Knowledge Management and Innovation at the Princess Margaret Hospital in Toronto.

Topics for discussion include:

• Should we be taking a patient driven approach towards our national electronic health records strategy?
• Does the PHR modify the risks related to privacy protection in a positive or negative manner?
• Do patient portals work or do they create a greater administrative burden for physicians and hospitals without true benefit to the patient?
• Could greater use of PHRs and Patient Portals shift the balance of accountability in terms of how personal information is collected and used?
• Do GPs and specialists see PHRs and Patient Portals as useful tools or just another burden in an overwhelmed system?

Would you like to submit a question to the roundtable expert panel?

You have until November 4th to submit a question for the experts by clicking on the 'Comments' link below.

Scanning Documents into an EMR and Paper Chart Storage

An article in the October issue of Technology for Doctors deals with the management of external paper and historical paper charts. Inputting this data into the EMR is extremely time and labour intensive. So what is a practice to do in the transition to the EMR? Read on....

Escaping the tyranny of paper is harder than most doctors imagine – even after an EMR system is implemented. Family practices often go into an EMR conversion believing they’ll finally be rid of paper going forward, and only have to worry about storing historical patient files. But storage costs for thousands of paper patient files can be expensive. By law, family practices need to retain patient records on-site for 10 years after the last visit. To avoid these costs, many practices are scanning them to create space-saving digital records, and they often assume this task can be handled by hiring temporary staff to scan old files over the course of a few months.

.....Most doctors have an average of 1,500 patient files each to scan, and many of these are several inches thick for longstanding patients with complex conditions. But few family practices have the high-end equipment needed to handle the job. “We didn’t have a proper scanner for our student to do that volume,” says Blankenstein. “We had a multi-function scanner, fax and photocopy machine that we needed for our regular office tasks. If she scanned all day, then we couldn’t use it for anything else. Doing the job in-house would have entailed buying another expensive machine, but we didn’t have the office space for another piece of equipment.” There were also some longer-term paper issues that came as a big surprise, he says. Even after the initial year-long teething pains of converting paper for an EMR are finally over, family practices need to consider that many laboratories can’t or won’t upload results digitally. They need to either make arrangements to scan these reports on an ongoing basis, or partner with select labs that can provide information electronically.

Read the full article in 'Technology for Doctors'

Scanning and data input is one of the high interest areas on CanadianEMR. How have you approached the challenge of managing your paper records and incoming paper results and reports. To add your comments, click 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.

Google Health Study - Nov 2009. How do Physicians use the Internet?

One feature of Twitter that I find particularly useful is the ability to identify lists of individuals with similar interests and review information that they have identified. It is like having an army of researchers at one's fingertips. This particular study, conducted by Google Health in August 2009 and just published, analyzed how US physicians are using the Internet. 411 physicians (GPs / Endochrinologists / Cardiology / Psychiatry) were surveyed over a three week period.

Conclusions were very interesting:

• The Internet is now an integral part of the physician's clinical practice
• The Internet and Search have transformed medical practice
  
• Physicians use the Internet round the clock in short bursts of time
  
• Using three words per query, they do one search and click on the top of the page on a result that is relevant to their query
  
• Search is a gateway to online health information but also used throughout the research process

Click here to read the Google Study (Formatting for this web page takes a bit of work to navigate)

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

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.

Visit my Photostream on Flikr

I am not sure how many visitors take digital photographs, but I am guessing it is a large number.

I was introduced to Flikr recently by Peter Morgan, a colleague who is working currently in Singapore. Visit Peter's photostream on Flikr

Social networking is integrating into many parts of what we do. In 2000, few were using digital cameras. They were expensive, provided low resolution images and were nowhere near film in quality. How quickly things change. By 2006, digital cameras were commonplace and soon surpassed film in quality and flexibility of use. Now a 10MP camera can be purchased for $200. The benefits of competition, innovation and a mass market. Something we still have to achieve with EMRs.

Click here to visit my photostream on Flikr

Some selected images:

 

 

Consolidation in EMR Market - QHR Technologies to Acquire Clinicare

November 9, 2009 - QHR Technologies Inc. (parent company of Optimed) today announced the intention to acquire Clinicare Corporation, a privately held Calgary based EMR company. Operations will consolidate under Optimed. QHR is acquiring Clinicare for $5,000,000, with an adjustment for net working capital. Initial payment to shareholders is scheduled for December 31, 2009 with final payments by January 31, 2010.

It was predicted some time back that as the Canadian Electronic Medical Market began to mature, consolidation was to be expected.

Read the full press release, click here

What are your thoughts? Is consolidation a good or bad thing for the market and for users?

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

2009 Survey of Primary Care Physicians in 11 Countries - The Commonwealth Fund

A 2009 survey of more than 10,000 primary care physicians in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States has just been released by The Commonwealth Fund. A similar survey undertaken by the same group in 2006 in response to the question, "Do you use Electronic Medical Records in your practice?" showed that Canada was last (with 23% reporting that they did use EMRs behind the US in second last place at 28%). When repeated in 2009 with a slight proviso (the question was amended to clarify the use of EMRs (not including billing systems) the US had increased to 46% while Canada had increased to 37% (still dead last). The gap has widened between the US and Canada from 5% to 9%. Remember this was all prior to announcing the ARRA funding in the US to support physician adoption of EMRs. You can be sure that when this survey is done again, US physicians will be reporting a signficant jump in the use of EMRs. Can Canada achieve similar increases?

While we are likely to see increases, because of a lack of a coordinated national strategy for EMRs (for primary care physicians and specialists), it is highly unlikely that Canada will be able to match the gains that the US will demonstrate. The $20 Billion+ that the US will be investing will ensure that EMR adoption will occur.

Critics of my statement above will point out that adoption of EMRs and the broad interpretation of use is extremely insensitive in terms of demonstrating how physicians are actually using their EMRs. We know that the numbers of physicians who use their EMRs fully is a much smaller number than those who state they have an EMR, however I would point out that having an EMR is the first step towards more effectively using your system.

Can we do a better job adopting EMRs in Canada? Without a doubt. Do we need to spend the equivalent of $20 Billion US to get there? I don't think so.

We have to be strategic, we have to create a value proposition for physicians that is a no-brainer, we have to ensure that information is able to flow EMR-to-EMR and between EMRs and the other third parties and we have to do this at the national level so that we do not strangle our EMR vendors who are already challenged to support multiple versions of their software in different provinces.

We have great EMR companies in Canada - no less innovative than anywhere else in the world, however they have little time and resources to innovate as they expend a good part of their energy achieving and maintaining conformance across multiple provinces. With the right support and facilitation, Canada could even become a net exporter of EMR technology as the developing world embraces EMRs.

To review the commonwealth fund survey data, click here.

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

H1N1 and EMRs - Where are the Benefits?

On October 13th, Reuters reported that one of the US EMR vendors had released an updated version of its software in order to enable paediatricians to more effectively manage their H1N1 vaccinations. In the US, the billing requirements for different health plans are complex (although the vaccine is provided free to the clinics through a government funded program).

H1N1 vaccine forecasting is complicated because doses are available in multiple forms (shots and nasal spray), and patients under the age of ten must return for a second dose 21-28 days later. In addition, attention must be paid to other vaccines given recently - including seasonal flu - that may interfere with this schedule. Otherwise the immunization may be less effective.

Read the full article

H1N1 vaccine has been administered primarily through public clinics in Canada, however selected physician practices have received vaccine to be administered to high risk patient populations.

My question is for Canadian physicians who are using an EMR. Have you received any benefit from your EMR in relation to the current H1N1 immunization program or to immunization programs in general?

To add your thoughts or comments, click 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.