Backblog | eHealth

In the past, I have written numerous articles describing the benefits and potential uses for EMRs for the management of patients with chronic diseases such as diabetes and congestive heart failure.

How does one prevent snooping of patient records through a hospital, regional or local clinical information system?

Few technologies have had as much of an impact on health information as mobile phones. It is unusual these days to walk into an examination room and not find a patient on their mobile phone, looking up information, playing games, or communicating.

One of the challenges that physicians face in their adoption of EMRs is the need to use multiple clinical information systems based upon their location(s) of practice.

A number of years ago, while working with Vancouver Coastal Health on a primary care health IT strategy, I had the opportunity to lead a project to develop local peer support networks or physician user groups (PUGs). The principle behind the groups was to find a way to bring together clinicians with a wide range of skill sets ranging from none to highly skillful in relation to EMR use and health IT. However, as with many of these types of strategies, programs such as this are difficult to sustain over the long term.

With the launch of the 7.9 inch iPad mini, Apple fired a warning shot across the bow of other hardware manufacturers with small form factor tablets, in particular, the 7 inch Amazon Kindle Fire and the Google Nexus 7. While these are competent devices and a little less expensive than the iPad mini (the Kindle Fire sells for $159 and the Nexus 7 for $199), the Apple eco-system is a tough competitor in the health care sector.

The concept of a “Medical Home” has been around for a long time. The American Academy of Pediatrics (AAP) introduced the medical home in 1967 and later expanded upon the framework in conjunction with the American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA). The current definition of the Patient-Centered Medical Home (PCMH) is “an approach to providing comprehensive primary care for children, youth and adults. The PCMH is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”

The following three-part series of articles have been written by a veteran software developer who has worked extensively in the EMR industry. The article series is published on his behalf. His comments are directed broadly at the industry.

The hypothesis is as follows: By automating the care delivery process with tools such as EMRs and EHRs, we have the opportunity to increase efficiency and reduce the cost of care by decreasing duplication of tests and investigations, lowering errors through decision support tools and reminders and identifying diseases earlier, thereby treating patients in ambulatory practices vs. expensive acute care settings. However, what if the hypothesis is incorrect?

Consider the following clinical scenario: You are a family physician in an EMR-based practice. One of your patients (a 65 yr male with Diabetes, borderline renal failure and Hypertension) presents with atypical chest pain. An initial assessment does not reveal an obvious cardiac cause for the chest pain, however you decide to refer the patient to a cardiologist for further investigation. The cardiologist identifies early congestive heart failure and decides to increase the dose of one medication, adds a new medication and stops another medication entirely. (The reason for a lack of specifics regarding the medications is simply to illustrate a point. This scenario could be applied to any situation in which multiple providers share care for patients and modify or add new medications to a treatment regimen)

Technology for the sake of technology has limited value, particularly in health care. The initial phase of EMR and information technology implementation by medical practitioners has been primarily focused on getting the technology in place and making sure it is deployed as comprehensively as possible. Once the EMR has been in place for some time (1-2 years) and there is a level of comfort and familiarity amongst the users, there is usually a natural transition towards quality improvement and optimization. As with all adoption curves, there are always a small subset of users who tend not to progress in their use and remain 'stuck' at a very basic level.

September is always an exciting and interesting time from a work perspective despite notification [via the Labour day long-weekend] that summer is over. How will 2013 differ from previous years in terms of adoption and use of health information technology in clinical settings? Here are my Top 10 predictions for the year ahead.

An interesting article in Technology for Doctors explores the question of Apps as prescribed treatment options for patients who have specific clinical conditions such as Diabetes or Depression. Canada Health Infoway has been funding a number of projects through the ImagineNation Outcomes Challenge including a smart phone Apps challenge focusing on consumer health apps.

The growth in the use of social media tools over the past 2 years has been astounding. There is nothing like an olympic games to highlight the benefits (and the risks) of social communication.

What does the future hold for small and solo GP and specialist practices in Canada? Are solo practices slowly moving towards extinction or is there a future for this traditional form of care?