Backblog | | eHealth

The majority of physicians I know are very protective of their personal workspace. They do not like outsiders traipsing through their practices, potentially compromising patient privacy. They also do not like having anyone mess with their computers, servers, EMRs, and billing software. After all, if it is not broken, why fix it? In a solo or small medical practice, it can be difficult to justify the expense of regular computer and network maintenance, particularly when it comes at a cost that exceeds the medical practitioners’ hourly revenue-generating capabilities. However, without maintenance, both short- and long-term costs of an EMR can be significantly higher.

The rapid transition to EHR and the integration of information technology in the delivery of patient care has had a transformational impact on medical offices and hospitals. There are many positive effects of the technology, including rapid access to laboratory information, diagnostic reports, and medication histories. However, there is also a potential dark side to the technology.

Despite the effort to create paper “light” medical offices, the likelihood (in the forseeeable future) that all data is going to flow electronically is extremely low. In fact, some would argue that we manage more paper now than in the past, with the exception of lab results.

The conversion of existing paper charts during EMR implementation is routinely seen as one of the greatest barriers to conversion of a practice to EMR. Chart conversion is a time-consuming and resource-intensive task that many physicians view as a hellish purgatory. In addition, ineffective and expensive chart conversion is one of the most frequently cited reasons for the failure of EMR implementations. However, there are several things your practice can do to help shorten and reduce the pain of chart conversion.

Anyone who has implemented and used an EMR is aware of the terms Privacy and Security. However, what do they mean and how does one apply the concepts to the protection of personal patient data in the EMR-based practice? Privacy experts will describe privacy principles as enablers in the development of the right technology processes and software. While this is true if understood and applied in advance, privacy can also be a barrier to adoption, particularly if software was never designed with today's privacy requirements in mind.

Many of Canada's provinces now operate EMR funding programs to support the purchase of EMR products by physicians. Some of the programs have already been established for some time and have been through multiple iterations (Alberta, Ontario). Others are much earlier in their evolution (Manitoba and recently, Quebec). In the short space of this article, it is not possible to do a detailed review of a single program, let alone multiple provincial approaches to EMR funding. As a result, what I would like to do is offer selected observations of the programs, what they have done well and what I believe they could do to make themselves more successful.

An important part of the mandate of CanadianEMR is to collect EMR satisfaction ratings from a wide range of physician users of EMR systems that are commonly used in the Canadian market. Ensuring the validity and currency of the rating data is of primary importance and to that end, we regularly send requests to verified users of EMR products asking them to keep their ratings current by logging in to CanadianEMR and checking and updating their rating.

Computers and EMRs are very good at performing repetitive tasks, particularly in areas such as appointment reminders for patients with chronic disease. Individuals with complex co-morbid conditions require a great deal of management, and generally this is more about consistently applying rules and reminders rather than dealing with acute complicating problems. Here are some important points to think about when using an EMR for automated reminders:

Along with millions of Apple converts, I have been following the announcement of the new Apple iPad at a live event in San Francisco. I have been tracking ABC News’ Joanna Stern via her live blog of the event. The majority of the announcements have been focused on the iPad’s enhanced processing power, the 2048 x 1536 resolution retina display, 10-hour battery life, higher resolution camera, and high-speed 4G LTE connectivity. Healthcare is likely to be a major benefactor of these features. Here is how I see the new iPad being adopted by clinicians.

Alongside its federally-mandated mission to accelerate the adoption of electronic health records (EHRs) in Canada, Canada Health Infoway does its part to help fund smaller innovations that highlight the power of technology to improve healthcare.

One of the challenges of any major change is a potential loss of productivity. Paper-based practices have for years optimized workflow in order to achieve maximum productivity in individual settings. As these practices transition to EMRs, some of the major challenges they face are the workflow changes necessary to implement and use the technology in clinical practice settings. This is not helped by the fact that there is limited ability at this time to exchange data with other providers and pharmacies through eReferrals and ePrescribing.

When using computers in healthcare, there is not much that seems more mundane (and irritating) than having to change your password on a regular basis. Government organizations and hospitals excel at requiring users to change their password every 42 days. Not sure why this particular number of days was selected - perhaps there is evidence that this is the safest time-frame.

Dr. Ann Cavoukian's presentation on why freedom of information matters and how organizations and individual healthcare providers can prevent privacy breaches. The 'circle of care', a term used in the context of sharing information with implied consent, is discussed as is Ontario’s Experience with PHIPA.

You may be a physician, software developer or may just see a business opportunity. Millions of dollars are bing invested in health IT and electronic health records. Healthcare costs continue to climb and the only logical solution appears to be process automation as has happened in other industries such as travel and banking. EMR adoption has stalled in a number of provinces. There must be an opportunity for a new EMR system. Right?

The Consumer Electronics Show (CES) in Las Vegas is the largest trade show of its kind worldwide. With 140,000 attendees, all the glitz and hype it’s all too easy to miss some really interesting new products that can be game changers.

It is more than one year since the US HITECH Act was announced, which defined the Meaningful Use incentive program to encourage adoption of EMRs by eligible providers including physicians and nurse practitioners. (Note: The terms EMR and EHR are used interchangeably in the U.S., although in Canada they applied specifically to physician systems vs. regional provincial electronic record systems.) So, what has happened in both countries over the past 18 months and how do the national programs compare against one another?

How many physicians are using social media for a variety of communication needs? While the number of physicians with Facebook accounts is likely to be significant, I am quite sure that the majority of use is personal. Some interesting questions are begining to surface regarding the ethics of using social media tools in clinical practice.

I had an opportunity to spend some time wandering around Vancouver last weekend and the one store that caught my eye was HMV at the corner of Burrard and Robson. Initially a flagship store for this retailer in Vancouver, HMV has tried to reinvent itself adding electronics and a variety of other mechandise to stave off the hemorrhaging from loss of sales of its traditional business — music. For that it can thank the revolution started by Napster with the final nail in the coffin being the launch of Apple’s iTunes store and a new model for purchasing music in which users were able to personalize their selection and disaggregate the individual tracks from the album.

I began to write this blog post using my newly acquired iPhone 4S, but once I had access to my laptop, I reverted to a more comfortable (and familiar) form factor. Until recently, I was a strong advocate for the Blackberry, which I have used for the last seven years; however, the recent network outage did impact me and resulted in missed calls and communications that needed to be acted upon earlier than received.

87% of Canadians support the use of electronic medical records (EMRs) and 9 in 10 people are interested in having access to their own medical records.

Medical resident data from the 2010 National Physician Survey was released on September 28 confirming widespread exposure to information technology while in training.

Nero (37 AD to 68 AD) is notoriously known as the Emperor who 'Fiddled while Rome burned'. While this idiom is recognized to be erroneous — the fiddle was only invented in the 16th century — it signifies 'doing something trivial and irresponsible in the midst of an emergency'.

In the tablet world, the iPad is king. Sony is one of the latest entrants to the tablet market with the release of their new Tablet S, however is the new Sony product an iPad killer (or even an iPad competitor)?

According to the 2010 National Physician Survey, 16.1% of physicians use electronic records instead of paper charts in their main patient care setting. (In 2007, this number was 9.8%.) While we see improvement in the adoption of EMRs over the three-year period, these numbers are not stellar by any means. There is a big difference between implementing an EMR and effectively using the system to enhance the way that care is delivered. The 2010 survey also indicated that 34.1% of physicians use a combination of paper and electronic charts — twice the number that use EMR alone.

What a tumultuous week in technology. Almost on the heels of the announcement that Google was buying Motorola, Hewlett-Packard announced the retirement of their recently released Touchpad tablet as well as a potential strategic change in direction from consumer technology products to business software with the spin-off or sale of their computer division. It is no small shift when the largest computer supplier in the world states they are planning on exiting the hardware market. Things are changing and fast.

Healthcare is extremely political in Canada! No big surprise to anyone who has been involved in health administration or planning, perhaps because healthcare is viewed as a national right under the Canada Health Act.

Paul Lepage, Senior Vice President of TELUS Health Solutions, dicussed the current shift in healthcare in Canada in his presentation The Care Continuum at eHealth 2011 in May.

The following email was received from a private diagnostic facility in Toronto. While it may be tempting to point a finger at the “for profit” nature of private diagnostics, competitive markets tend to drive efficiency and non-performers simply go out of business. As more physicians adopt EMRs, the demand for ways to leverage EMRs and improve efficiency is bound to grow.

Funding programs to support EMR adoption have been available in Canada for almost 10 years. However, these programs were never intended to fund EMRs indefinitely.

There is an interesting thread of conversation that is beginning to wage on adoption of EMRs by physicians. This was triggered by a comment made by Tom Closson, President and CEO of the Ontario Hospital Association (OHA), at the recent eHealth Conference in Toronto.

From time-to-time, one reads about security breaches as a result of a computer being stolen containing patient's personal health information or breaches as a result of a network being hacked (as occurred recently to Sony's online gaming community). However, as more information is stored in the 'Cloud', how secure is that data and how worried should we be about breaches?

The 2010 National Physician Survey Results are now available online. The numbers tell an interesting story regarding the adoption and use of EMRs.

Along with millions of others, earlier this week, I watched a very frail looking Steve Jobs address attendees at the Apple Worldwide Developers Conference in San Francisco. In addition to demonstrating new operating systems for the Mac and the iPhone/iPad, Apple announced the new iCloud service.

Do you have a job opening you would like to post? Job postings are open to anyone involved directly or indirectly in healthcare as a physician, practice manager, program administrator, vendor, or a healthcare IT professional.

At CanadianEMR, we receive information and feedback from many sources: physicians who submit EMR ratings, users’ comments on the CanadianEMR blog, communications from media and industry representatives, feedback from practice managers and administrative staff. As a result of all of this feedback, we function to some degree as an early warning system. Even if comments are not explicit, it is possible to draw conclusions from overall feedback.