Practicing in Electronic Islands!

Last week I had an opportunity to participate in a panel discussion at the eHealth 2004 conference in Victoria, BC. In conjunction with two co-presenters, Dr. Jay Mercer (Ontario) and Dr. William Haver (Saskatchewan), we provided a bird's eye view of practicing in three different provinces (Ontario, British Columbia and Saskatchewan). The experience is overwhelmingly similar in each province.

Despite using Electronic Medical Record systems in each of our practices, we are unable to fully utilize the technology due to the lack of communication capability with other physicians and health providers, hospital and community based information systems.

The challenges revolve around the flow of information and the fact that we are still living in a paper world to a large degree. Until there is a widespread capability to easily share information 'laterally' and securely between providers, it will be difficult to achieve successful adoption and integration of EMR technology.

The debate has raged over the need for a single standard EMR system that all physicians could use vs. free market forces and many EMR systems that are all built to certain standards with the ability to trasfer information between systems.

In Richmond, the community in which I practice, I am leading a group of physicians to explore the opportunity for a single standard EMR platform for use by all physicians in the community (specialist and family physician). Has any visitor to CanadianEMR had experience with a community wide rollout of EMR? Any thoughts - either pro or against such an approach? To share your thoughts, click on the 'Comments' link below.

Comments

[fred freedman]

Unfortunately I have no such experience. Toronto is totally anarchic and too big to organize.
I agree with your approach as the only way to realize real gains with EMR is to be integrated with other users for easy information communicability.
The difficulty is, of course, getting different people to agree on a single platform. However, from what I've seen in the marketplace, most programs are really quite similar. If the vendor/developer keeps a wide latitude of flexibility (eg: template customization) this shouldn't be a problem.
Let me know how your plans progress.

[Jel Coward]

What a great coup for vendor to be the 'chosen one', what power and leverage. I would support a single EMR but it should be open-source if users and patients are to be protected.

[EMR@saveslives.org]

If one of these EMR companies had any guts they would open source their EMR, provide it for free and just charge for services.

There would be an army of doctors willing to help each other with customization templates and stuff.

I suspect as some of the emr companies go belly up they might open source their EMRs as a last ditch effort.

[Karim Keshavjee]

At this point in time, I think it would be premature to have a single vendor provide an EMR. My personal experience has been that different physicians have different preferences for the user interface. Since you will likely be spending 25% of your time with patients documenting the encounter, you should purchase an EMR that 'fits' you. There are still too many differences (inspite of the similarities mentioned by Fred) --we have not seen a Dominant Design in EMR yet.

I would be furthering the standardization agenda, not the single EMR agenda at this point in time. Even the UK and Denmark have multiple EMRs --not a single EMR.

As an experiment, it is worth doing --if you can get consensus on that level.

[Alan Brookstone for Brian Nelligan]

The following posting was submitted by Brian Nelligan from Interior Health Authority and is posted on his behalf:

We don't need a single EMR, what we need are the vendors to agree to a format to export and import data. This data should be securely sent to any practice that can access the Internet. BC has a group of vendors that sign agreements that they will conform to a standard that has been set by the MOH. This gives the ability to send patient information to the patient's specialist or new family doctor as well as to receive consultive reports back. The MOH in BC is also looking at giving the physicians in BC the ability to send data files to each other in a very secure format. This is all we really need, the ability to share information securely and in an accepted format.

Brian Nelligan
brian.nelligan@interiorhealth.ca

[Johnny Liu]

Hi, I am currently doing some market research on EMRs and have repeatedly ran into information saying that there is no standard format allowing physicians to share patient data with each other. This might sound dumb, but why can't physicians just take a screenshot of their patient's records or transfer it into a word format (cut and paste) and transfer it over via e-mail or even fax it over to another physician? How would physician data be ideally imported and exported between EMRs?

Also I have heard that the HL7 standard allows EMRs to exchange data. Is some information lost or scrambled when transferred through this HL7 standard? Is this HL7 just a standard of patient information data fields that should be included when patient data is exchanged or is it actually a data exchange software platform?

I would really, really appreciate it if someone can answer all of my quesitons. I have been struggling mightly with these questions for some time. This would really be of tremendous help to me. Thanks!!!

[Alan Brookstone]

Johnny, I will try answer your questions to the best of my ability. I am sure that these are questions many physicians face and have difficulty understanding.

Sharing information between physicians (i.e. at a community level) requires that the individual EMR systems need to talk to one another and have the ability to transfer data in a format that is readable by the other system. This may require an information broker (a 3rd party that is able to receive the data and then put that data in a format that is readable by the other system). An interface allows 2 different systems e.g. hospital and community EMR or two community EMR systems to communicate directly with one another without the need for an 'information broker'. Unfortunately many of the these interfaces are yet to be built and can be quite costly. As a result it is still not possible to transfer data between many systems.

Taking a screen shot or cutting and pasting information is possible, but is very time intensive. In each case, you have to perform many individual tasks to get the job done. The ideal solution is to be able to decide what information needs to be transferred to the other physician, select by using a number of check boxes and then automatically generate the document from the data that has been captured in the EMR.

Ideally, information should be seamlessly transferable between physicians. Just as paper is exchanged between physicians, it should be as easy to send information electronically, arriving in the EMR in-box and then after being read and having the appropriate action taken, it should be filed in the appropriate patient record.

HL7 is one of a number of data standards. What HL7 does is provide developers of software with a data format that is common amongst the different systems. If data is sent in a format e.g. abcde, the system receiving the data should be designed to read it in the format 'abcde', not 'adbec'. Any data standard will allow this process to take place in the context in which the standard has been developed. Some standards are designed for X-rays images, others for lab results and others for clinical data.

I hope this answers your questions. If other contributors would like to embellish upon my answers, please add your comments.