Upgrading our EMR software

Our EMR software needs to be upgraded. The version we are currently on does not conform to the new OntarioMD requirements (Clinical Management Systems Version 2.0). We are getting the upgrade next Tuesday.

I view upgrades with both anticipation and trepidation. The anticipation is about the new features (improved medication management, vastly enhanced ability to search the record). The trepidation is about the unknown problems that we will face: will our printers and labelers still work? Are there bugs that we are not aware of?

These programs are now so complex that it is impossible to predict what changing things will do. As well, each province sets its own requirements for EMRs, and the software applications are programmed to meet these requirements. The requirements are usually tied to funding, and are thus more important than user requests; you get the system you plan for.

I understand that it is quite expensive for each EMR company to meet the requirements, on the order of $200,000 to $300,000 per province. This will make some of the smaller companies drop out of the market (not necessarily a bad thing in the long run). However, there does not seem to be a rigorous process for testing the new software, which means that physicians and other front line users are exposed to what is essentially an untried product. Even Microsoft can have missteps with new releases (see Vista).

Another issue is the interoperability factor. Some large physician groups have managed to negotiate a connection between their system and their hospital's system. However, these are currently one-off solutions, meaning that they cannot be replicated. The difficulty here is that the software upgrade needs to be tested in the environment it is currently in to guarantee continued interoperability. Two things can happen:

1. Testing does not happen, and interoperability (or parts of it) fails with the upgrade, or
2. Testing does happen, but only after a long delay; that group is now several versions behind their colleagues

I hear that these issues are common in the business world as well. Even large, enterprise-level databases (such as Oracle or SAP) cannot be completely tested; the results of new implementations can be dropped customer orders, difficulties connecting electronically to large external customers, materials being shipped in twice the quantity ordered due to software bugs, and difficulty with planning production due to missing/incorrect information. Testing can take so long that implementations are rushed in due to deadlines, with unknown consequences.
It takes time, money and work to fix the universal initial software problems, and these may be less available in small medical offices than in large corporations.

We received a 47 page document a few days ago on what is available in the new version of our EMR, as well as a 10 page document on medication enhancements. I am going through the documentation in preparation for the upgrade. However, I am concerned about my FHN colleagues; most of us are unprepared, and have had no training with the new version (and may not have the time to go over the documentation). I think what will happen is we'll get the upgrade, I'll give it a few weeks to see what the issues are, and then we'll schedule a booster learning session for my FHN. I think some formalized training may be useful: it is not necessary to train the whole group; having a web session for the "super-users" may be what's needed, as we can then spread the knowledge to our colleagues.

Michelle