Sunday, December 16, 2007

Divorce, EMR style

At a recent OntarioMD meeting, several of my colleagues who are early adopters talked about being on their second EMR system. I've also heard from colleagues who are not happy with their system, and my new partner is now on her third EMR system because of changing to new practices.

I think going electronic is a bit like a marriage; you use the darn EMR all the time, sometimes it works and sometimes it drives you crazy. If it drives you crazy enough, then you get a divorce, which is difficult and expensive, but is sometimes necessary. No guarantees on whether the next partner will be any better.

There is no way that the electronic data from my partner's previous practice can get transferred to the new EMR. Her previous office manager is printing the charts of patients who are following her; she has to then re-enter the CPP. We are scanning the old charts that are arriving into the office's external hard drive. This is the current state of affairs.

In Ontario, all approved EMR applications will now have to be portable; in other words, you will be able to transfer data to a new EMR vendor if you switch. This document has what must be portable on page 40 and on. It is a bit difficult for me to understand, but it looks as if most of the CPP, lab and clinical notes are in there. I can't imagine that is will be easy or seamless, since EMRs store things in all kinds of different ways, and in all kinds of different databases. I'd like to see this in action; I think the most important piece will be the CPP.

In my EMR, I now see a Data Export and Data Import piece, so they are getting ready for this.

Having some data that is similar across EMRs is a good idea; perhaps one of the unintended (or maybe intended?) consequences of this initiative is that there will be a common CPP that can be transferred back and forth to hospitals, home care, and specialists when needed.

It is interesting that I have not heard of instances where the divorce was back to paper; the difficulty is with the initial transition to EMR. There is no reversion back to paper, but there is failure to launch EMR.

My Family Health Team is getting ready for the big move; about half of the physicians in the Team will move their practice to the same premises as our Allied Health Professionals. This looks like it will definitely be happening in 2008; I will be moving, along with my new partner and a third physician. Our AHPs will be getting EMR training early in the new year. It will be interesting to see how things get integrated. I've been asked to talk to the FHT Allied Health about medical directives in the new year, so now I have to think about what I would like them to do.

Three of the practices that are moving are now on EMR, and two will be transitioning after the move. On the Master Plan, there is space allocated for high density filing for the non-EMR practices only; I cannot see much wasted chart areas in the EMR practices. I will not be moving any paper charts to the new office; others in my FHN who are moving are now disposing of their paper as well. One physician has moved files to her home, another to a storage company, RSRS (and she is quite happy with the service). I think we are starting to witness the beginning of the end of paper records.


1 comment:

Scott Ferguson said...

Based on my personal experience in the area, your observations about being on second and third EMRs (particularly for those in the early adopter group) is something I hear often.

Having a more common way to exchange patient history between EMRs will be a welcome (and necessary) feature as EMRs continue to prgress and adoption continues to increase.

One of the often overlooked or neglected areas of the EMR transition is how to handle getting the patient history (paper records) into the computer so everything can be accessed on screen at the point of care.

Many time practices have a two or three year old implementation, but still have a chart room full of paper records that haven't been addressed because of the painful process of scanning directly into the EMR or the high-cost and high-risk of outsourcing the scanning work.

There's a company called ChartCapture that has recently come out with a product to bridge the gap between the paper charts and the electronic record. They're demo video is really neat, you may find it interesting to share with colleagues who are preparing for the transition or still wrestling with it.