Sunday, February 22, 2009

The spread of EMRs

We had our monthly departmental meeting recently; about 50 to 60 local family physicians regularly attend. These colleagues tend to be more involved in the department (teaching, committees etc) than those who don't attend. My hospital is community-based, but has a strong teaching mandate, especially in family medicine; several of us are involved in research activities.

Our Chief asked people who are or were about to start using an EMR to raise their hands. About 85% of those present did so. Granted, this does not represent all of the family physicians in this area, but it was impressive to see this. Perhaps we have a technology cluster in this area. Certainly, EMR is a frequently mentioned at our meetings. We recently had a brainstorming session for priorities for our department at our executive; members then voted on their top two priorities. The #1 priority was linking the hospital and the community EMR electronically: we all want to reduce scanning. This has not happened yet, but now there is vocal demand for it.

I belong to a Practice Based Small Group (PBSG); we meet monthly for ongoing medical education, since 1995. A year ago, I was the only one using an EMR. This year, out of 11 physicians, three are currently using EMR, three have purchased and are about to start, and two are in the process of buying an EMR. Only three of us do not have immediate plans to start. We use four different EMR systems, which is going to make sharing information and EMR processes a little challenging!

I think that, at least in some geographic areas, we are now past the early adopter stage, that is, an Early Majority of physicians are now purchasing these systems. Purchasing does not mean implementing; I think we will continue to see implementation failures, and the focus of support may need to change towards supporting those who have purchased, rather than encouraging purchases.

I write the occasional PBSG educational module; we have just finished work on the module on Depression. It incorporates some information relevant to physicians using EMRs. I think EMR-specific information will become increasingly added to other types of medical communication and educational materials, as more physicians adopt these systems.

I will be attending the Quality Improvement and Innovation Partnership (QIIP) introductory meeting this week. This is for members of Family Health Teams interested in systematically improving quality in their practices. Although having an EMR is not a requirement, I don't think that many QIIP Teams are still paper based; it is simply too difficult to audit practices without electronic means. Our FHN administrator, our RN, our FHT Clincal Pharmacist and Dietitian are on the Team. It is a good mix. The FHT Executive Director and Medical Director will also be coming. We have two EMRs in our FHT, so a team using the other EMR application will also be participating--and I think this is a very good thing. Unfortunately, some of us have become very proprietary about our EMR application (my EMR is better than yours), and we sometimes forget that we are all on the same Team. Having us participate as a Team in the same project will help us figure out what is similar about our EMRs, and how we can run programs in common across applications (at least to some degree). Or, perhaps we'll have some competition as to who can provide better quality--and that's not a bad thing to be competing about.


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