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“EMR 2.0: Are Canadian MD’s ready?”

Posted Oct 10 2008 2:10pm

This is the second in the series of articles on Thought Leadership issues written by guest authors including CEO's or founders of EMR companies. All articles have been reviewed prior to publication.

By Eric Gombrich, CEO EMIS Inc.

If one looks at the evolution of the physician’s office electronic medical record (EMR) in Canada, it is clear that the industry was spawned with an eye towards the administrative aspects of running a physician practice. It began with electronic billing which delivered the benefit of greater revenue and/or reduced costs; always a critical consideration for any business endeavor. It then evolved to include scheduling of patients as an extension of the billing process, or as a general office function.

For purposes of primarily logic, users then began to ask if things such as electronic prescribing could be added as a means of improving the legibility of the scripts, and enabling administrative staff to manage the refill process more efficiently. In some cases, but not all, the solutions evolved to begin allowing physicians to enter patient problems, chronic conditions, and in the most of advanced solutions, physicians’ notes.

While programs such as Alberta’s ground-breaking POS program and others have enabled, we’ve seen a dramatic increase in the use of EMRs over recent years. However, while the public figures demonstrate tremendous success in the uptake of EMRs, there is a different interpretation if one scrutinizes the figures with a sense of diligence. In fact, while Alberta’s POS program claims success with over 65% of MDs using and EMR, Infoway’s latest analysis suggests fewer than 15% of MDs are actually themselves using the EMR for clinical purposes.

The primary intent of serving a clinical purpose requires that we need to think of the EMR in a different way. It starts with a premise that the primary user of the EMR is the physician, not the administrative staff. It strives to be such an integral part of the physician’s clinical practice, that in terms of usability and benefit, the EMR is compared to things like the stethoscope and X-rays.

In fact, it is not unlike the transition physicians were asked to undertake when progressing from a world of X-Rays and transcribed reports, to one of digital modalities such as CT, MRI, and PET scans and they were provided access to see the actual studies through PACS solutions. As this transition ensued, physicians not only had more personal interaction with what many consider subjective test results (e.g., “How well do I know the radiologist that provided this interpretation?”), but there simply was much more discreet, objective information. The technology augmented what the physician knew or had time to interpret.

I like to think of this shift from the administrative EMR to the clinical EMR in Canada as “EMR 2.0.” It is not merely an “update” to the EMR, but a quantum leap in what it is, and how it can and will be used by physicians to deliver care. For example, in the administrative EMR, we seek an acceptable Summary Care Record. In this paradigm, the physician wants a clean, simple, overview of everything relevant for the patient in order to enact making care decisions. But in the Clinical EMR paradigm, the EMR is relegated – and trusted to – serve the purpose of presenting what the physician needs to know based on the decision the physician is making. In such a paradigm, the Summary Care Record becomes less important, because the EMR serves as the co-pilot, not merely a digital chart.

We see similar evolutions occurring all around us. Take the gas gauge on your car. That gauge itself is similar to the Summary Care Record in that it tells us how much gas is in the car before we venture off on our journey. But if I look at the gauge with the intent of calculating how far I can go, it becomes a process of work in and of itself. Go back 20 years and consider this. How many of us actually did the calculation? Or did we instead start on the journey, and just watch the gauge until it reached a point of discomfort and then we stopped to refill. In that process, how many of us has reached a point of being “below the line” and sweating, wondering where the next service station was? How many actually ran out of gas?

Fast forward to 2008. We have GPS systems that are interfaced to the car’s computer. We simply set the destination, and the vehicle allows us to proceed. It notifies us when we are passing service stations. Some are even capable now of making recommendations as to the service stations we should seek based on pricing of the fuel. But the point is that these new systems being integral parts of our driving experience, and they do much of the tedious administrative work. They even progressively alert us to the impending fuel “crisis” we are heading towards as we continue pass service station after service station.

Is this not what physicians seek when they desire “chronic disease management?” Or do they really only desire to have a form produced? Do physicians really want another summary view of the patient’s chart or do they want an intelligent system that alerts them to something relevant for that patient, at that time, in that clinical paradigm, thus saving them time and enhancing care?

Are Canadian physicians ready for this new paradigm of EMR 2.0? I hear physicians say “I don’t want to really use the EMR, I want my staff to use it,” or “We don’t want to change that much.” While I am not a physician, I will not be as arrogant to state these attitudes are misguided or wrong. Having worked with physicians and allied healthcare providers for over 25 years I’ve seen the herculean efforts they put forth because they truly care; I am the last person to espouse how they should do their jobs.

But as a father and a husband, I will personally seek to find physicians who recognize there are clinical tools that augment their processes so they can spend more time with my son or daughter delivering care, and less time on administrative tasks. I will look for physicians that recognize the right EMR can be a true ally in their clinical arsenal to improve the health of their patients, in much the same way they leverage the latest diagnostic imaging and laboratory procedures, as well as therapies. These are widely recognized as being clinically important to the health of the Canadian populace. But I’m not convinced the Canadian physician community as whole is prepared to make the transition to use these tools.

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