A friend of mine sent me this link - "Beware of the EMR ‘Ponzi scheme,’ warns physician leader" — earlier this week. The article starts off by saying:

Healthcare IT does not necessarily make life easier for primary care physicians, says a leader in the movement to make medicine more efficient and patient-centered.

"When you put an EMR into a primary care practice, your life is hell for the next year," said L.Gordon Moore, MD.

"EMR vendors aren’t really giving us what we need. We have to make a distinction between a robust EMR with decision support tools, and one that is just being marketed as a way to improve coding. And we really need to get out of the E&M coding game."

Yikes. I’ve been in the healthcare IT market for a while and that’s probably one of the strongest anti-EMR statements I’ve seen publicly.

I know I have many readers who are physicians — how many of you concur with Dr. Moore?


Shahid N. Shah
The Healthcare IT Guy

Caring.com is an excellent example of how to use Web 2.0 for improving patient care — by targeting not just those affected by illness but actually helping those that are caring for the patients. Caring.com’s focus on eldercare (adult children caring for aging parents) is a good one and should prove profitable. I really like their "to do list" ideas that give actionable advice and specific steps for how adult children can care for their elderly patients.

Seems like a good start. I’d like to see more "calculators" and tools added (like how much time should be spent on specific ailments, how often there should be doctor visits, a scheduler that might send out reminders, etc). I think the eldercare industry is going to explode and Caring.com seems to be in a good position to take advantage of the opportunity to help.

Shahid N. Shah
The Healthcare IT Guy

• Create a social network of your family members and share your medical history with them. It would be interesting to see if they make a facebook application soon to tie in with other social networking tools.
• Discover and learn about the health problems that run in your family – including conditions that might not otherwise be considered by your physician.
• Discover if you or your family members could benefit from specific diagnostic, genetic or screening tests.This is probably the area they are making money so it’s good to see a viable business model.
• You can share your family health history with your physician and receive better guidance to delay, improve or even prevent bad health. This is a good way to promote the service, too.
• Although I didn’t try it, they claim they can Import your family tree from genealogy sites like geni.com and ancestry.com.

I don't know about you, but I am getting tired of reading articles in journals and in the media that point to Canada being the slowest to adopt EMRs in the developed world! The recent article in the NEJM (see below) points out just how rotten we are and in a race with the US for worst track record. Despite my unhappiness, I am not disputing the data, I think that it is quite accurate and that it is an embarrassment.

What I would like to see is a better understanding of our current state. Simply stating that clinicians are technophobes is not only inaccurate, it simplifies a very complex situation and does not provide any concrete solutions.

I have spent a great deal of time and energy looking at the physician adoption of technology over the past 10 years, trying to understand the barriers and to identify where we should be focusing our energy.

Here is my Top 5 list of areas to focus on that will support adoption and use of EMRs by physicians:

1. Focus on matching technology to the work patterns of physicians and their staff. We have not done enough to understand the needs of GP/FPs and Specialists and the importance of ensuring the EMR systems allow GPs to send referral letters to specialists and that consultation letters flow electronically from specialist to GP;
2. Ensure that funding programs to support uptake and use of EMR systems by physicians are inclusive of GPs and Specialists. Funding purely focused on primary care adoption of EMR will not help us solve the issue that I have identified in my first point above;
3. At the very minimum, ensure that specific data is able to flow between different EMR systems according to messaging standards such as those adopted in Denmark and New Zealand. This will enable the transfer of referral and consultation letters between systems in addition to other critical data;
4. Facilitate electronic prescribing by streamlining the prescribing capabilities of EMR systems and allow prescriptions to flow electronically between physicians and pharmacists;
5. Support the development of medical device standards for monitoring and diagnostic devices. This will ensure that a level of plug-and-play capability is reached so that it is possible to use any device with any EMR or EHR. In the same way that we can currently plug in a mouse or a printer, this capability should exist so that we allow physicians to select the EMR system that meets their needs and then choose their devices rather than choose an EMR based on compatibility with a device.

Read the Ottawa Citizen article:

"The Ottawa Citizen - Tuesday June 28, 2008: Canada is in a tight race with the United States for an unwanted title: slowest adopter of electronic medical records in the developed world. Only one in five, or 20 per cent, of American doctors uses electronic medical records, the New England Journal of Medical reported this month, and less than nine per cent of practices with three or fewer doctors use them. In Canada, according to the 2007 National Physician Survey, fewer than 10 per cent of doctors have switched entirely from paper to electronic records, though about a quarter use some combination of the two. The stubborn attachment to old fashioned filing cabinets is unfortunate. Digitizing medical records reduces medical errors, improves preventative care and saves administration costs, and Canada is so far behind most other countries in this area that it's embarrassing.

"The benefits to patients and workers, however, are too great to ignore. In this sense, the situation is analogous to that facing other industries, which deal not with patients but with customers. Adapting to technologies requires an outlay of money and resources, but without these investments it will be impossible to remain productive. Organizations plagued by inertia and technophobia will suffer, and that includes public sector health care organizations. To their credit, the federal and provincial governments have invested more in health-care information technology than has the U.S., but that is a meagre accomplishment. We should strive to be better than second worst."

Read the full article: Unhealthy technophobia