Transition to EMR difficult but essential

The implementation of electronic medical records (EMRs) is not a choice for physicians, but an inevitable step towards fully utilizing IT in Canadian health care, according to industry experts.

“We’re trying to run a 21st century health system using 19th century paperwork,” said Richard Alvarez, CEO, Canada Health Infoway.

Eliminating x-ray lag time, medical record access and a constantly updated medical file are only some benefits of EMRs, proof that full adoption is necessary and critical for the future of Canadians, Alvarez said.

Incorporating EMRs into the health system has to do with timing, according to Bill Pascal, chief technology officer of the Canadian Medical Association.

“The EMR market has only become aggressive in the past three to four years and it took Canadian banks 20 years to introduce IT,” he said. “However, since the announcement of [federal] government funding in Jan. 2004, more physicians are jumping on the EMR bandwagon.”

One such physician is Dr. Michelle Greiver, a family doctor based in Toronto, who began the process of bringing EMR into her practice in May 2005.

“I wanted to do it for 10 years, I just couldn’t,” she said. “The software wasn’t ready and it was too expensive and no one else had done it.”

Greiver can be considered an early adopter of EMR, said Pascal. He noted the conservative majority (roughly 80 per cent), will not adopt technology until EMRs have been more established in the marketplace.

Moving forward with 17 other doctors, Greiver and her partners collectively decided on Nightingale Infomatix Corp.’s software. Her group’s membership in the Ontario Family Health Network allowed for government subsidies of roughly 70 per cent of her start-up costs.

Choosing a vendor is a long and detailed process for doctors ensuring quality software, said Pascal who wants to see vendors put to the test to guarantee quality for physicians and patients.

“You have better functionality; you reduce the problems of integrating EMRs in a regional health authority or provincial health system around messaging (and) technical compatibility,” he said. “Only the companies with software standards that are high enough will be able to survive.”

On Aug. 2005, Canada Health Infoway and Global e-Health Innovation created a laboratory in Toronto, managed by the University of Toronto and their University Health Network affiliate where vendor products will be screened on-site for qualities such as interoperability. Compatible software, adequate training and support are all issues for the future cohesion of IT products in health care.

For Greiver, seven four-hour sessions of training on the Nightingale software was provided by the company.

Despite lessons hosted by EMR businesses, often the support offered isn’t enough for those questioning to make the move. Whether responsibility lies on the software company, government or medical associations for providing transition support is up for debate.

“The major reasons that EMR projects fail is because the change management was poor or non-existent,” said Pascal.

Pascal advocates for more industry-push to help realize EMR’s presence as an instrumental tool of the future. As such, physicians need to recognize the steps needed to make the shift as smooth as possible.

Dr. Alan Brookstone, a physician based in Richmond, B.C, said the main challenges are in areas of business process changes, impact on workflow during the transition period, and computer skills.

“Their work efficiency will go down until they get used to a paperless environment,” he said. “The barriers are fairly clear and consistent and are irrespective of what part of the country [a physician is practicing in]. It will take time, frustration and adjustment.”

Greiver said her biggest test was adjusting to new procedures. In addition to including EMRs into her revised practice, software included a new billing and scheduling system, and although difficult, the result was more precise patient care.

Without the help of her staff who diligently worked with her, Greiver said she wouldn’t have been able to improve her practice through EMR use.

Staff members also feel the effects of using EMRs as responsibilities shift. In Greiver’s practice, duties began leaning more towards telecommunication with patients and in-office computer dialogue.

“They are taking on more clinical responsibility,” said Greiver. “When someone calls and I have a message, it’s typed on a messaging system attached to the chart. It’s in the records and it keeps track of everything well that way.”

Scanning documents, doing returns, EMRs, logging refills are some examples of changed responsibilities for physician staff, said Davinder Gurm, Nightingale business development manager.

Tasks change for staff members but technology features, such as a reminder option in the software program, enables a doctor to receive electronic notifications when a patient requires an annual test, according to Greiver.

Dr. Greiver believes technology greatly improves administrative efficiency and the level of patient care.

Merck and Co.’s Vioxx recall in Sept. 2004 had physicians sifting through paper files to find patients users. This, said Greiver, is why EMRs are so vital to the welfare of patients.

“With a click of a button, I could have easily accessed long-term users of Vioxx and informed them more quickly. Whether exams or drug recalls, EMR technology cuts administrative time allowing for more patient care.”

Currently Greiver is in the process of fully implementing EMRs into her practice.

“You just keep plugging away. Things are going to happen, nothing is perfect.”

Greiver has chosen to document implementing EMR into her practice on her website, .

Brookstone’s website, Canadian EMR, is aimed at providing an open forum for physicians, addressing EMR concerns in Canada, .

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