Thinking about my new office presents challenges. I may have to change some of my technology (phone, fax), and rethink some of my practice processes (again).
For example, should I consider VOIP (internet-based phone)? What about Internet faxing? A fax line costs $50 per month; Internet fax costs about $10 per month, there is no need for a fax machine, and it is always on (without the need to leave the computer attached to my fax on). Long distance is free. My secretaries are already faxing directly from the computer more and more often. We can use the scanner to fax things that are paper-based. On the other hand, I don't know if Internet fax is secure, and I have not seen how it works. I really don't know anything about VOIP.
We will have many physicians and allied health workers in the new office; there will be 5 practices, each with 3 to 6 physicians. Our Allied Health Professionals will have their central offices there. The FHT administrative offices will be there as well. All of us will be on the same EMR system, and the plan is that physicians will be able to access it remotely for booking. EMR training for our AHPs has just taken place. We will need significant Internet bandwidth to take care of all this, and probably someone on-site to manage the IT. It is exciting, but also more than a little scary to me; it feels just like before we embarked on the EMR project, with many more questions than answers.
My group is now starting to think about what to do when our EMR contract expires, in 2009. We can choose to remain on the hospital-based server, or go to ASP. Our provincial subsidy ends after three years, so we no longer have to comply with the provincial stipulations (use SSHA's internet lines, use a Certified EMR etc). Many of my colleagues in Ontario are going to be in the same boat.
The benefits of staying with our current server are that it is a known quantity. However, it will need to be upgraded (we are taking on new physicians, and the amount of data going in is increasing).
The benefits of going with the SSHA ASP is that provincial healthcare data is going there, so there is a better chance of linking with the rest of the system. Hospitals and Home Care are sending data there. However, much of this is still theory, not fact. The drawbacks are that we have to continue to deal with SSHA; this has not been a physician-friendly (or even customer-friendly) organization in the past.
The benefits of going with the company's ASP (which is not Certified, we could not do this under the terms of our current contract) is that we can access over regular internet (faster than SSHA). This is much simpler and easier.
I am leaning towards the SSHA ASP. I know the problems with SSHA; however, I do think this type of structure gives the best chance of having the data follow the patients. As well, we need to have our data professionally managed and backed up; I was speaking with someone who had been at at physician's office, and saw a sign asking people for patience, as they had lost two months of data. I worry about the small servers in solo or small family practices; not all of us are good at backing up our data. Data loss happens, not everyone is careful; while there are risks in large data centres, I think the cumulative risks in many small, unsupervised practices are likely greater.
I was looking at CanadianEMR, and saw that the results of the 2007 National Physician Survey are now available. It looks like 19% of family physicians are now using a combination of paper and EMR records; that may well represent people currently transitioning to EMR. 12% of us are using EMR only; that must be those who have completed the transition. The total for EMR (full or partial) is 31% of family physicians; for all physicians under age 35, it is 45%. These are much higher rates of adoption than previously reported, and the numbers may mean that we are now in the "early majority" phase of EMR adoption.