Friday, February 16, 2007

Working with your EMR company

After 10 months, I have a fairly good idea of how to work with the EMR company. My most common contact with the helpdesk is by email; if I can't get a good answer, I contact the helpdesk manager. Phone calls to helpdesk are rare, because I find this inefficient; it is more useful for things that are urgent or that are not getting resolved by email.

Some things are more of a "wish list", and I know that I may or may not get them. They get sent to the development team. As an example, I use "profiles", with the assessment ICD, medication and follow up preprogrammed (cystitis-595, Septra DS bid x 3 days, push fluids); I would like to have a bill pre-programmed as well. I think if there are lots of physicians asking for the same thing, it is more likely to happen. The on-line group that I belong to is monitored (we sometimes have a reply from someone at the company), so ideas from there likely percolate to development. We are getting an upgrade at the end of the month, so I'll find out then about the extra things.

My husband works in the coatings industry; they use a very large company for their corporate database, SAP. He tells me that despite millions spent on implementation, there are still problems, and upgrades are very expensive. His company also bought a colour computer to help with color matches; it took a year to get that working properly, and several sister companies never did get theirs working.

It is still not clear to me what the critical elements are for a successful transition. In the Compete study in Hamilton, 25% of physicians abandoned the EMR at the end of 3 years, and there were still 22 chart pulls per day after 18 months. I think there are also transition problems in South Western Ontario, at the DELPHI project. These projects provided a lot of support and help. It is unrealistic to expect 100% adoption (or to have everything working within half an hour); it looks like the major issue is the management of all the changes, and surviving the turbulence. There are other physicians like me who have managed the change, I wonder if we could help our colleagues. Some of the information will be company-specific, but some can be translated across all EMRs.

The EMR provided an unexpected finding for me this week. When managing depression, I have an alert in the chart for my staff to print a PHQ-9 questionnaire before I see the patient. Often, patients don't return for follow-up. A couple of days ago, I saw a lady for a sore shoulder, and she handed me a PHQ. She was seen for depression 6 months ago, but did not return for follow-up visits and did not get treated. Her alert remained in the chart, and so a questionnaire was printed for her when she came in. Her PHQ is now completely normal--she got a better job and fired the bad boyfriend. Now I wonder what the natural history of depression in primary care is; perhaps I'll get to find out a bit about what it is in my practice.

I am finding some creative uses for the EMR. I have put information on the home BP machine that I recommend in my list of prescription favourites, so now it prints as a prescription. Maybe I should do an exercise prescription next.

I guess with EMR,
You can't always get what you want,
But if you try sometimes you just might find
You get what you need



Prakash said...

What type of EMR software is best suited for you

Do you go for the Client server type or the Web based EMR type? With no simple answer on which is better you’ll need to decide what’s important to your practice and what’s not.So lets try and look at the pros and cons of these two sytems.

Web based EMR:

The Web based EMR is a remotely hosted software system accessed via an internet web browser, similar to the model used in online banking. This remotely hosted system is accessed by paying a rental or service fee.Though the initial cost is low in the beginning it usually ends up being more expensive than the Client/Server-based system.

The advantages are :

1. You don't have to worry about the technical aspects of the server as this is managed by a professional IT company.
2. Data Back up and other service related services make it a very effective option.

The draw backs are:

Most of your data is being handled by a third entity. The are chances of missuse of data. And you almost certainly want a high speed cable connection.That means you are dependent on Internet connectivity.There is also the risk of data being inaccessible in the event company goes bankrupt.

The Client server model:

The advantages are:

1.Faster overall operational speed since we are using a local network
2.You have control over your own data
3.There is no dependency on internet connection

The draw backs are:

1. A much higher upfront cost of ownership as a server and software must be purchased upfront.
2. You may maunually have to acquire new product updates
3. Online backup must be purchased as add-on.

What ever said and done, It finally boils down to which system is best suited to your practise.

The author Prakash is a support Manager at

Michelle Greiver said...

Thank you for your comments. We went with what Dr Brookstone calls a "remote server" model, which is a single server (located at my hospital), with the 9 physicians in my group, practicing out of 7 different locations all accessing the data via broadband. The reasons for this are detailed in the initial postings in this on-line diary. The hospital's IT manages the daily back-up, validation, and maintains an off-site copy of the data as part of their IT routine; the EMR company manages the software and upgrades. We own the hardware, software and data. I believe that applications using "remote" or "local" servers may be a better description of the EMRs adopted in Canada.

For a spirited discussion between proponents of either model, I suggest the following posting on CanadianEMR:

Personally, I remain a fan of the remote server concept, especially for small, geographically dispersed practices like my group, or if allied health personnel are hired for the whole group. I think we are getting close to using some of the "Enterprise" functions of the EMR as a group. For example, our clinical pharmacist will be able to access all the charts if we decide to go with a quality improvement project for diabetes (including all the schedules), through a single log-on. The same goes for the nurse-practitioner etc. I was also able to set up some flow sheets for one of my colleagues in my group.

This aspect is not mentioned in your posting. EMR goes quite a bit beyond hardware and software issues; IT consultants also need to think about the re-engineering of health care itself.


internal medicine emr said...

You know what, I agree with you. Sometimes they're just thinking on what they want and not on what they really need.