Sunday, February 17, 2008

EMR for the non-believer

My practice partner will be implementing the EMR. This is not because he strongly believes that it will make a difference. He is doing it because EMR comes as part of a package: we have decided to continue practicing together; he is joining my FHN; he will be joining the FHT; he wants to move with us to the big office. EMR comes as part and parcel of all of those, and the benefits to him of going in this direction outweigh the risks of staying put. This is called "relative advantage", and I think this calculation is increasingly tilting in favour of Electronic Records.

I do not think that doing this type of calculation makes you a "bad" physician, or an "IT laggard". I think it is a realistic assessment for many of my colleagues, given the initial difficulties with implementing EMR. I also think that it is up to our health care system to help us; EMR subsidies are important. Other possible rewards are giving incentives for quality of care (such as the preventive care incentives in Ontario) that are easier to track and measure through EMR. I would like to see more of this; these incentives will drive the programming of EMR systems towards making sure that we can measure and improve what we do. This programming is still in its infancy.

Another very important aspect is making sure that we are connected: reduce the amount of scanning due to non-EMR data, help to ensure that other parts of the system accept EMR generated forms. This is not something that can come from physicians, it must come from the top (leadership). If a private Diagnostic Imaging facility can send me reports directly into my EMR, I am more likely to refer there. I wonder at which point competition will come into play; I would prefer to remain within the public system, but will use private facilities if their care is better because they are connected.

What I am trying to say is that there is a very important role for government, and for policy-makers. There is a role for incentives that favour adoption at the same time as quality of care; we also need policies that promote effective and efficient information transfer, instead of the current status-quo of outdated forms and processes.

I just went to a conference on the management of mental health issues, which I attend annually. At the conference, several of my colleagues told me that they were about to adopt an EMR, or were in the early transition; this is a change from a year ago. A physician who started using an EMR two months ago told me that his staff are unhappy, and that it is hard for him because everything is taking so much longer. He had a realistic assessment of this, however, and told me that he knew the early slogging was tough, and that things would get better; he wasn't giving up. EMR even came up in one of the small group meetings (these are run by a psychiatrist and a GP psychotherapist); a family physician said that prescribing some of the complex psychiatric drugs was now better because of the automatic interaction and allergy checking. I do not think that the GP psychotherapists are adopting these systems; these physicians restrict their practice to talk therapy, and I cannot see EMRs as having a relative advantage for them. There will likely be corners of the medical system with late or non-adoption; however, these will run the risk of being disconnected from an increasingly inter-connected system.


No comments: