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

By Sam Solomon, National Review of Medicine April 30, 2007

“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.

1 LEARN WHAT’S OUT THERE
Research, research, research. And then do some more research. That’s the advice from Dr Alan Brookstone, a Vancouver GP and the creator of Canadian EMR, an industry-funded project designed to help Canadian doctors choose EMR software.

Your most important source should be your fellow physicians, he says. (But don’t forget to make sure they aren’t shareholders or board members of the company they recommend.)

Vendors may offer demonstrations of their products to help you get a better look at them. Or you could go to a nearby clinic to check out their system first-hand.

Don’t rely on the internet too heavily; just sifting through the software company’s website and separating the gibberish from the gems could take longer than it took to earn your MD.

It’s important to include all of your practice’s physicians and staff in the decision process to ensure everyone is on the same page, adds Dr Brookstone.

More research sources will soon be available, including a full version of Dr Brookstone’s Canadian EMR project, which will feature a comparison tool to allow physicians to look at other physicians’ ratings of EMR software based on a number of criteria. (The site, which is not yet fully operational, has a physician-only blog located at emruser.typepad.com.) Canada Health Infoway is also developing a set of standards that it intends to use to certify EMR software.

Full article here: http://www.nationalreviewofmedicine.com

Realistic expectations can help your conversion to electronic health records succeed.

David E. Trachtenbarg, MD March 2007 AAFP

Two physician groups implement the same electronic health record (EHR) system. One improves quality of care and productivity and saves thousands of dollars. The other reports more errors, loses efficiency and teeters toward bankruptcy. What’s the difference, and how can other EHR users achieve the results of the more successful group?

Having realistic expectations about what EHRs will do for your practice and how they’ll work is a key to effectively selecting and implementing an EHR system, but too many groups set themselves up for failure by beginning without a clear sense of what they will achieve. This article offers suggestions for dealing with 10 common misconceptions that lead physicians off course on the EHR journey. It is based on my experience purchasing and implementing an EHR system for a 120-provider, 30-site group, as well as my discussions with physicians from more than 50 organizations about their potential EHR purchases. It includes a few references to EHR studies, but, like the authors of one literature review, I found that information on EHR use in primary care was a “descriptive feast but an evaluative famine.”1

Myth 1 – A new EHR system will fix everything

Some groups want to purchase an EHR system to help transform their organization and take it to the next level, but they may be expecting too much. In the book Good to Great, author Jim Collins observed that technology works as an “accelerator of momentum, not as a creator.”2

An EHR will not fix organizational problems, and it does not guarantee improved efficiency and quality. In fact, installing software is just one part of a journey toward improved efficiency and quality.

Fact: An EHR system is not a panacea. The transition will create new problems in addition to solving old problems. Think carefully about whether your organization is stable enough to handle the challenges.

Myth 2 – Brand A is the best

I’ve met physicians who would never seek out an expert on hypertension to ask, “What is the best drug for hypertension?” yet they search high and low for tech experts to ask, “What is the best EHR software?” Just as it is for hypertensive drugs, the correct answer for EHR software is, “It depends.”

Fact: There is no perfect software. You should expect your EHR software to do some things well, some things so-so and other things not at all, and what works well for one group may not work for another. The following three considerations will help guide you:

1. Determine your vision. Is it that better documentation will enable you to maximize billing or achieve outstanding disease management or something else? When my group was thinking about which software to buy, we summarized our vision for the EHR system in the phrase “Networked physicians, shared care.” Starting from that vision, we tried to purchase software with features that could promote communication with other physicians and integration with other hospital systems.

2. Determine the scope of the project. For example, are you a solo physician in a single office, or will the project involve many physicians located at multiple sites? Some systems are better for small practices, others for larger groups.

3. Determine what other systems need connections to the EHR. Consult with information technology professionals to make sure the software you choose will work well with your other systems.

Myth 3 – Our software needs to work the way we currently work

After one consultant advised my group to produce the best paper record possible and then convert it into an electronic record, one of our physicians commented, “So we should make the best horse and buggy possible and then use it to create an automobile?” We passed on the consultant’s system, though the exchange raised an important point: To maximize the benefits of an EHR system, you need to take advantage of its positive aspects by changing your workflow to accommodate them. It will not be possible to continue doing business as usual.

Fact: An electronic record is not a paper record on the computer, and you will maximize your efficiency only by making significant changes in your workflow. Expect to work differently to make the most of the EHR system’s advantages as well as overcome its disadvantages compared to paper (yes, you will find some).

 Continue the article here: http://www.aafp.org/fpm/20070300/26ehrs.html

This tiny, bare bones ‘micropractice’ is FP Gordon Moore’s idea of paradise. No secretary, no nurse — and no hassles

By Peter Woodford April 30, 2007 National Review of Medicine

“In many ways this is a Norman Rockwell practice with a 21st century technological backbone,” muses solo FP Dr Gordon Moore of his Ideal Micropractice vision, speaking to NRM from his tiny Rochester, NY, office. “I’ve had some docs who’ve been practising for 35 years who’ve said ‘you haven’t invented anything here’ and they’re right — I’m just using technology to make it possible today.”

Exactly what Dr Moore, who’s also a researcher at the Institute for Healthcare Improvement (IHI), is doing will strike many doctors — particularly Canadian MDs — as completely nuts.

Imagine answering your own office phone and giving out your email address and cell number to patients. Throw in some same-day booking and 30 minute patient visits and you start to get an idea of how things work in Dr Moore’s office. But there’s a method to the madness — in fact it was his IHI research that led him to hang out his micropractice shingle. Well, that, and the pressure to see more than 30 patients a day at his former group practice in a big HMO.

It’s been six years since he said goodbye to group practice, and he admits there are some adjustments to make. A doctor who opts to follow the micropractice model — no secretary, no support staff, just the doctor and his computer — can expect to make less money than by joining a traditional practice. The dollar difference largely depends on how good one is at keeping down costs but as a ballpark estimate, expect to earn 30% less than you would in a group.

So why would anyone want to take a pay cut? For pretty good reason, says Dr Moore: micropractice docs get to spend more time with patients, be their own boss, and generally be under less stress. “The joy-of-work quotient for us in our practices is huge,” beams Dr Moore.

THE FOUR PILLARS
For Dr Moore, if a micropractice is to work it requires four things: great access, enhanced patient interaction, reliable clinical care and practice vitality in the form of low overhead. He’s a big proponent of open-access scheduling — also called same-day booking — as a solution for access problems. “We think open access is a delight for patients and less work burden for a practice because we don’t have to negotiate a delay — you’ll be telling them “Sure, come on in today,” he says.

But giving patients his cell phone number and email — meaning he’s essentially always on call — is a recipe for disaster, right? “No, the inappropriate call is a very, very rare event. People are very respectful. It’s been a delight compared to working in a call group, which I found overwhelming,” he says.

Continue article: http://www.nationalreviewofmedicine.com