Monday, August 17, 2009

Of concrete blocks and EMRs

I am moving to my new office on August 22nd, next Saturday (or at least that was the plan). A 20 foot block of concrete fell from the third floor on the back entrance of the building where my new office is located last Friday.

We thought the building would be closed for several weeks; the city evacuated it that day. Two Family Health Team practices had already moved in, and the FHT head office is in the building.

Over the weekend, physicians made contingency plans. The practices that had already moved in are all using EMR through remote access. A call was put out to host fellow family physicians; all that was needed for them to access their records was internet access. These physicians had switched their phone system to VOIP, so were able to port the phones to other offices if needed.

Several physicians had hired a private company to scan all their old paper records; the company generously offered to make the copies available to the physicians if needed (paper charts were trapped inside the building). Secretaries were able to access the scheduler remotely to phone patients with appointments. Labs continued to come in electronically. The main issues was with the fax machines, as these were located inside the building, and incoming information could not be accessed or uploaded to the EMR.

It was very stressful, but also very interesting to realize how portable the information now is; this was good demonstration of disaster recovery. Had my colleagues still been using paper, their patient records would have been completely inaccessible. We also continue to need to work to decrease the amount of data coming in by fax.

I updated our practice website with the information; it was not clear over the weekend what would happen.

Finally, we received word on Monday morning that the building was re-opened; access was through the underground parking, which had been reinforced. Everyone was to stay away from windows until notified otherwise. We could move next weekend, although with some restrictions.

We had developed a communication plan for my practice should the move be cancelled. Our summer students were going to call all patients booked after August 21st. We were going to update our voicemail system and website. I thought about sending out an "allpatient" email relating the issue; although we have started collecting emails, this is still at an early stage, and we cannot do mass emails for now. It may be good to try at some point in time, we may need the ability to send something quickly out to all registered patients in the event of an outbreak. I don't know if there are any rules yet around mass emails from physicians; this is likely coming, we probably should start thinking about what is appropriate and what is not.

Email communication with patients itself is becoming more difficult to manage. Although I have communicated by email with patients for over 10 years, I am not sure that I should continue to allow this type of communication. We have been discussing email at QIIP, and here is what they said:

"A clinic email address for general inquiries would be adequate and admin staff could manage the inbox. However, for services like prescription renewals, medical advice (non urgent of course) or any other service that involves a healthcare professionals, a more secure line of communication is necessary. "

Our medico-legal insurer, the CMPA, has also recommended stricter rules for email; I have added a link to their disclaimer on my email signature. Email security and encryption is impossible for me to manage; a proposed solution is to only allow patient email through a portal, such as It costs $240 per year, and each patient must pay $20 per year. I am not sure at the present time. I like the fact that this is secure, but I'm not sure about the payment. As well, my email has now been widely disseminated; I don't know how I would manage a switch to a portal instead of "plain" email. I also frequently email patients links directly from an encounter (for example, the DASH diet for patients with hypertension), and I'm not sure if I can continue to do this through a portal. I'll have to think about that one.


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