CanadianEMR: EMR Comparisons, Ratings and Expert Discussions

BCMJ: How I learned to stop worrying and love the computer

This very humerous overview of EMR selection and implementation was published in the April edition of the BCMJ. While tongue-in-cheek, the article highlights some very real issues that physicians face when implementing an EMR.

"Like many of you I had been wondering if it was time to modernize and consider an electronic medical record, or EMR for short. I was growing tired of using an archaic implement to scratch barely legible words across our pulped forests. I was constantly impressed by my forward-thinking colleagues who had already adapted to this brave new world and spoke confidently, throwing around terms like gigabyte, megahertz, and snack bites. How difficult could this be? I am a man of the 2000s. I am adaptable and rapidly yet seamlessly adopt new technologies. Well, there could be a first time.

My colleagues and I carefully researched all the available medical software packages, and after an ex­hausting review chose the one that appeared to fulfill our needs most closely. “Carefully researched” is really a loose term which means we chose the first one we were presented with. In our minds we were now ready to proceed.

Oh right, you need computers to run the software and apparently you need more than one. We contacted a computer company who came into the office and, after assessing our needs, produced a quote. Who knew that you also need printers, scanners, cords, and software to run the medical software you have just paid thousands for? I was assured that the quote wasn’t for gold- and diamond-plated hardware despite the number of zeros along the bottom. Oh well, we reasoned, sometimes you have to spend money to leave the old days behind.

We were ready to begin. “Who is going to network the cable throughout your office?” the hardware guys asked out of the blue. “What networking?” I asked. “Don’t you guys do that?” “No, we only set up the machines in the offices and make sure they work. Someone else has to run the cable through the office.” Read the full article>> BC Medical Journal - BCMJ.

Have you had experiences with EMR implementation that mirror those of Dr. Richardson? To add your thoughts or comments, click on the 'Comments' link.

Unanticipated Costs: The Need for a Project Manager when Implementing a EMR

Ask just about anyone who has implemented an EMR and they will tell you there were unanticipated costs that were incurred through the process over and above what was initially projected. The additional wall mounts for laptops, uninterrupted power supplies and extra network drop points that needed to be installed in the office are just some small examples.

When selecting and implementing an EMR, physicians are faced with a multitude of questions. The obvious ones relate to the selection of the system that will be right for that specific practice and physician mix, however there are other fundamental questions that are brought up through this process. How long is the current office lease? Is this a time to move into a group practice and share costs and overhead with a group of physicians? Is it possible to use existing space and exam rooms and repurpose physical rooms to accomodate an EMR system?

The importance of a physician champion in a practice to lead this process can not be underestimated. In fact, this is probably the single most important requirement when implementing. However this individual takes on a great deal of responsibility and commits time and energy in the process.

Recently I have become more aware of physicians that are coming together in groups of 8-12 to set up new practices that accomodate other care providers such as dieticians, nurse practictioners and pharmacists. Financial incentives coupled with the ability to provide shared care supported by an EMR are a catalyst to move in this direction. Planning and management of this implementation can be a multi-year process and is not a simple task to undertake. The most valuable commodity that a physician has is his/her time and if not seeing patients, that physician is not generating income. So, the question of additional needed resources comes to mind.

I was talking with a physician colleague recently who established a 10 physician clinic. The process from planning to design to occupation of the premises took nearly 2 years and included bringing multiple physicians together who had worked in smaller practices geographically separated from one another. The only way that this could be managed efficiently was to employ a full time project manager for approximately 1 year. The cost was in the range of $10-$15,000 per physician. His comment was that it would not have been possible to manage the project without this additional set of hands (and come out sane at the other side).

Questions to readers of this blog who have made a transition to a group practice:

• Did you use a project manager to assist you in the process and what were your experiences?
• If you did not use a project manager, if you had to do it again, would you employ a project manager to assist your group?

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

Using EMR in Clinical Practice - Video Presentations

How do Electronic Medical Records affect lives. In a special report from Canada Health Infoway, a number of scenarios are highlighted through video. Click here to view this page

On November 24th, 2006, OntarioMD hosted two breakout sessions at the Primary Healthcare Update Conference. One of the most informative presentations was entitled "Assessing and Integrating EMR into your Practice". The presenter is Dr. Stephen McLaren - Markham Family Physicians. Click on the following links to view the presentation.  Windows Media  Quicktime

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

Variations in Clinical Adoption of IT Amongst Physician Specialties

A very interesting study, published by the 'Center for Studying Health System Change' looks at the different adoption rates amongst different specialties. This is no great surprise as the workflow for different groups of physicians may vary quite widely, however the ability to quantify this information in a meaningful way is what makes this study stand out.

Differences in IT access among sub specialties were even greater, particularly for medical sub specialists. Psychiatrists were substantially less likely than the comparison group of other medical sub specialists to access IT for all activities, except writing prescriptions. In contrast, oncologists were much more likely than the comparison group to have access to IT for guidelines and exchanging data with hospitals and physicians.

Among surgical sub specialties, ophthalmologists lagged the comparison group of general and other surgical sub specialties for all measures but obtaining guidelines. Obstetricians/gynecologists (OB/GYNs) were less likely than the comparison group to access notes and exchange data with physicians or hospitals.

Among primary care sub specialties, the major difference was that pediatricians and general and family physicians were less likely than internists to access IT for patient notes.

Link: Clinical Information Technology Adoption Varies Across Physician Specialties.

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

CanadianEMR Star Ratings will replace 'EMR User Experiences'

An 'EMR User Experience' posting was published at the time CanadianEMR was launched in January of 2004. Between 2004 and 2006 a number of contributors posted comments about products that they were considering to purchase or were already using.

Much has changed in the past 3 1/2 years. Some of these companies have gone out of business, others have been acquired and are now run and managed under new names. Some products that were referred to no longer exist or are are offered in a different format. As a result, much of this information is inaccurate or no longer relevant as it is not applicable in September 2007.  As a result the old posting has been removed in preparation for a new service that will soon be provided.

A new form of 'User Rating System' will be soon be available

At CanadianEMR we have been working diligently with the input of multiple vendors and physician advisors. This work has resulted in the development of the CanadianEMR Star Ratings, a new feature that will be available in the next version of CanadianEMR which will launch before the end of September 2007. In preparation for the launch of the new web site and for the reasons mentioned above, 'EMR User Experiences' has now been removed. Although physicians will be able to rate their EMR system from the time of launch, the Star Ratings will not be displayed immediately as we want to ensure there are both a relevant number of raters and a level of confidence that can be applied to the ratings. We will publish the full methodology and the rating criteria on the CanadianEMR site before the first rating is displayed.

Briefly, the way it works is as follows: Star Ratings are generated by physicians who use EMR systems in their practices and who have taken a few minutes to respond to the 15 questions necessary to rate their EMR. These 15 questions are divided into 5 measures of quality - Purchase experience, Implementation experience, Support experience, Usability and Satisfaction with the product. The questions are answered simply by clicking on a star rating of 1-5 for each question. If a physician wants to contribute to the EMR user ratings and rate their EMR system, registration is required. In order to rate, a physician must be a validated user of that product and have used it for a period of at least 6 months. After completing a short questionnaire and a disclosure statement regarding any conflict of interest, permission is requested to contact the EMR vendor simply to confirm use of that EMR. Once confirmed, the user rating will be published to the web site and will be incorporated into the overall rating. Raters will be encouraged to return from time to time to let us know how their EMR system is doing, particularly in the areas of support, usability and satisfaction with the product. As a result we will be able to display a dynamic view of how a company is performing, the number of physicians who have rated that product, the length of time a product has been rated and a range of other measures. We believe this will be very useful to users and potential purchasers of EMR systems.

All physician ratings will be anonymous and any personal information used to create a user account will be treated as highly confidential according the CanadianEMR privacy policy.

I look forward to your thoughts, input and contributions to the Star Ratings. If you have any questions or comments regarding the Star Ratings, please click on the link below:

Going Electronic in Six Painless Steps

Just published in the National Review of Medicine, this article describes six steps towards going electronic in a medical practice.

Forget the rumours — the switch from paper to computer records doesn't have to be a nightmare.

"I'd like to..." laments Dr Kalyani Srinivasan, a GP in Fredricton, NB, about the thought of switching from paper records to a computerized system. "But the cost — in time, money and effort — is tremendous and I don't have any of the above to meet the challenge."

It's a familiar refrain. Ask almost any Canadian physician if they're planning to adopt an electronic medical record (EMR) system and the answer invariably begins, "Sounds great, but...."

In fact, Canadian docs came dead last in EMR use compared to other industrialized nations' physicians in a survey last year by prestigious US-based healthcare charity the Commonwealth Fund. Just 23% of Canadian primary care physicians have computerized their patient files, in stark contrast to Holland's sparkling 98% mark. If those were MCAT scores, the Dutch would walk away with all the big grants and the cushy fellowships — and Canada wouldn't even get into med school.

EMR systems have been shown to help reduce adverse events, improve communication between health providers and keep a tighter lid on health record privacy. Sure, the prospect of going electronic can be intimidating, but it doesn't have to paralyze you. Follow these six simple steps to guide you through the research and implementation of an EMR software system.

They are:

1. Learn what's out there
2. No practice is an island
3. Tech support
4. Talk out loud
5. Sign up and set goals
6. Gradual switch

Link: NRM - Going electronic in six painless steps.

Do you agree that these are six steps towards establishing an electronic office or are there additional steps or lessons that physicians should be aware of in considering this move. To add your thoughts, click on the 'Comments' link

Debunking EMR Myths

This article was published in HealthLeaders Media (US publication) in November 2006 and lists a number of myths relating to EMR selection and implementation. It is worth reading.

Debunking EMR Myths    If you ask James Holly, M.D., if there are any misconceptions about electronic medical record systems, be prepared to sit a while. An outspoken champion of clinical IT, Holly has used an EMR at his multispecialty group practice for eight years. The 26 physicians at Southeast Texas Medical Associates have retired their paper charts, using an EMR to document all aspects of clinical care. Holly, chief executive officer of the Beaumont, Texas-based group practice, led the automation charge because, as he puts it, delivering high-quality healthcare simply demands it.

But physicians like Holly remain a minority, as only some 10 percent of physician practices have automated their clinical recordkeeping, according to most estimates. Hospitals, too, remain burdened under the heavy yoke of paper charts. Many run partially automated, hybrid electronic-paper environments. Like Holly, executives involved in hospital deployments invariably can talk at length about the misconceptions of advancing documentation into the modern age. Here are five common EMR myths.

1. All EMRs are alike
2. EMRs are a fad
3. The technology is the hard part
4. The software is the expensive part
5. Computers interfere with patient relationships

To read the article, click on this link: Debunking EMR Myths

If you would like to add thoughts or comments, please click on the 'Comments' link below.

Peer Support - How Important is the Assistance of Colleagues when Adopting an EMR?

Much work has been done internationally to accelerate the adoption and use of Electronic Medical Record systems by physicians and their staff. The influence and support of 'peers' is felt to be very important. Peers include colleagues in the same practice or in the community who are experienced users of technology and EMR. These individuals are felt to be important influencers and teachers/educators of others.

Have you perhaps taken on the role of a trusted peer in your practice or in your community? How important do you think this role is in terms of moving ahead the adoption of tools like EMRs? Do you know peers in your community who play this role?

The objective of this posting is to gain a better understanding of factors that impact the adoption of EMR. Please share your thoughts and comments bly clicking on the 'Comments' link below.

What are the EMR Needs of Surgical Specialists?

I recently received a question from a surgical specialist regarding the choice of an EMR system. I have posted the question and my answer and encourage sugical specialists who are currently using EMR systems or who have gone through a process of selection to provide feedback on this question. I do not believe that there has been nearly enough attention to the needs of specialists when it comes to EMR system selection, so any feedback or advice that you can provide will be greatly appreciated.

Q: I am a plastic surgeon in Quebec looking to change to an EMR type of format. Would you have any suggestions of where to begin???? Apologies for the open ended question.

A: I believe that surgical specialists face a different set of requirements in terms of their need for an EMR. In my experience there is a much greater need for efficient transcription (and a business case in terms of savings) than for the full primary care type EMR which is more easily adaptable to medical related specialties.

That being said, if you are interested in pursuing an EMR for your practice, I would suggest that you speak to surgical specialists in your region to determine whether there is a system or systems that are predominantly used. The advantage will be that there could be existing interfaces to hospital, lab and medication information that will be useful to you. I am not aware of specialist EMR systems in the Quebec market, so this will take some research.

My advice would be to spend some time on the CanadianEMR site to learn a bit more about requirements. Then develop a clear inventory of your needs and prioritize the list e.g. you may find that the ability to use speech recognition and integrate transcription is more important than access to medication information in your practice. Once you have defined your top 5 priorities, use that list to short list potential EMR systems. If you cannot find a system that will meet your needs and assist you in your practice, it may be more prudent to wait for an appropriate system to become available rather than attempting to implement a system that requires a lot of workarounds.

To add your comments and suggestions, please click on the 'Comments' link.

Dr. Greiver's EMR

As Canadian physicians adopt electronic medical records, and go through the process of selecting, negotiating terms and implementing systems in their offices, a growing body of knowledge and experience is developing. This hands-on experience is extremely valuable as it refelects actual process and issues faced by our colleagues. The selection and use of an EMR is a journey. This is aptly refelected in a chronological diary written by Dr. Michelle Griever, a family physician practicing in Toronto, Ontario.

Dr. Griever has begun implementing an Electronic Medical Record in her practice, beginning in March 2006. She has created a blog as a diary of her experiences.

I highly recommend that you read this blog. Michelle begins with making the decision to implement an EMR. She then describes the process of applying for funding for her network of physicians, finding the resources to assist with selecting a system, reaching concensus on a decision and then selecting an EMR product. This is particularly pertinent for Ontario physicians.

If other physicians have a record of their EMR selection and implementation experiences, please forward the links or content to me for inclusion on CanadianEMR

Click here to view Dr. Greiver's EMR blog. If you would like to add your thoughts, click on the 'comments' link below.