The Bridge to EMR... Document Management

Each week in my work, I either meet or speak with physicians who are just starting to warm up to the idea of electronic medical records.  They're feeling the push from the folks at OntarioMD and Infoway Canada , or they're watching some of their "forward-thinking" colleagues take the leap.  Or perhaps, like so many, they're simply up to the gills in paper and realize that they either have to consider a bigger space to accommodate the accumulated boxes of inactive records they must still retain, or start thinking about the bigger picture of how the records are managed.

Technology has a way of eventually breaking down your front door if you wait too long to graciously invite it in.  It eventually starts to feel like being the only one at the dance without a date.

In the meantime, the latest statistics in Canada indicate that the uptake to EMR is still slower and far lower than expected.   

Unquestionably, the leap to EMR from a paper-based practice is a quantum one. 

But there is an interim step out there that is often overlooked.  This bridge to EMR, not only rids the physician practice of all new paper, it also affords the physician some additional time to better weigh the EMR options out there.  The bridge is called Document Management.

A Document Management System might be
the perfect bridge and interim step to EMR.

In its simplest form, a Document Management System (DMS) is a software application which tracks, stores and allows for immediate retrieval of electronic documents or images.  It is not specific to medical offices, but lends itself beautifully to one.

In the case of a medical practice, the DMS will store each patient record digitally and allow for instantaneous retrieval of that record through its search capabilities.  Once retrieved, the record is similar to the paper record in that you can flip through the record one page at a time by using the arrow button or "next page" button, just as you would use your finger to flip through a paper record.  Any paper coming into the office, be it through fax, mail or even handwritten notes, can be scanned in to the DMS at the end of the day, with each new page appended to the top of the existing digital record for that patient.  Plain and simple.

Document Management Systems vary greatly and usually offer additional functionality such as: annotation tools (highlight, circle, redact, etc.), ability to zoom in and out, rotate an image, print, share, etc.  When set up for it, the DMS can be accessed via any secure internet connection (ie. the home, or hospital).  It can be fully secured, and there's an audit log showing the date and time and username for each activity that takes place within the record.

Compared to its big brother EMR system, the DMS is inexpensive (imagine a $1400 one-time fee per concurrent user license).  It gets rid of all paper going forward.  It prepares everyone for a paperless office environment.  It buys you time to figure out which EMR system is really right for you, while letting the EMR market mature a little more.  And when you do finally make the move to EMR, it will not be quantum leap, but rather a small footstep.

For a solid DMS with a great track record in the medical sector, RSRS recommends Digitech's PaperVision Enterprise, which can accommodate small to very robust requirements.   Here are case studies where PaperVision was implemented in a Single Physician Practice, A Large Clinic, and a Hospital.

EMR is not the only way to do away with paper in a medical environment.  DMS is a very viable option, both as an interim step to EMR and even, dare I say, as an alternative to it.

The EMR Challenge... Collaboration!




Collaboration is key to successful EMR adoption

 I note the words of Richard Alvarez, president and CEO of Canada Health Infoway in today's Globe and Mail newspaper.

When asked why there wasn't faster uptake of Electronic Medical Records by Canadians, Mr. Alvarez replied:  “I would say it's not technology or money that's lacking but a culture of collaboration. Once you have that – ... anything is possible.”

That got me thinking...  He may be on to something there.  While I've always assumed that similar to when any new technology is introduced, the Technology Adoption Curve  applies.  There are going to be the "Early Adopters" followed by the "Early Majority", "Late Majority", and then, "The Laggards" (also referred to by some as "The Skeptics".  And it would appear by the statistics of late, that we're well into the Early Majority stage in Canada.  And the pace of moving from one stage to the next with respect to EMR is not totally unexpected, to me anyway.  We are, after all, a pretty conservative country, and we do like to think a little longer before making wide-sweeping changes.



However, I believe that Mr. Alvarez is really on to something when he suggests that a "culture of collaboration" is missing.




The Technology Adoption Curve & EMR



As a company that works to facilitate medical record storage for retiring, relocating and deceased physicians, RSRS also facilitates the transfer or medical records to the patients and/or to a new doctor.  It never ceases to amaze me how many doctors are still a little reluctant to relinquish copies of the records, to their patients, let alone to new doctors.  There seems to be a tendency to want to safeguard the information, and release it only as an edited summary.  The reason given is often something along the lines of:  "They don't need to see this or that..".  It's only when these physicians are reminded that the patient has a legal right to view the entire record, and in fact, is the legal owner of the information (not the paper though), that the physician reluctantly agrees.



Is it a fear of possible misdiagnosis?  Omission?  Wrong protocol?  I'm not really sure, and admittedly this issue comes up less with the younger doctors who have understood from day one that the records they keep are subject to inspection by a multitude of other authorized parties, not the least of which is their accrediting College of Physicians.

Collaboration is a necessity - certainly when it comes to health.  Physicians learn from other physicians.  They also learn from their patients, who are in the best position to communicate historical issues not immediately available in their medical records.  The patient really needs to have full access to their healthcare picture.  They don't need to understand it all, but they do need to be able to access it, and any good EMR system should have this accommodated.

I believe that the faster that the new breed of EMR's facilitate a safe environment of collaboration for both physician and patient alike, the sooner we move well into the "Late Majority" adoption phase for EMR's.

Healthcare in Canada Ranks Lowest!!

In an article published November 7, 2010 in Toronto's Globe and Mail newspaper, Canada was ranked the lowest out of 7 countries when it comes to the Quality and Timeliness of healthcare.  The newspaper article, entitled Canadian health care on the international scorecard, ironically cited Canada as having the 2nd highest rating for Long, Healthy, Productive Lives.   In other words, despite the supposedly poor quality of care and the delays in its delivery, we are living healthier and longer lives than most countries in the world.

The study, conducted by The Commonwealth Fund, also shows Canada as having the lowest number of doctors / 1,000 population (2008) at only 2.3%, as compared with the U.S. at 2.4%.  The highest percentage goes to Australia with 4.6%, where they are also ranked Number 1 on the Long, Health, Productive Lives meter.

Canada is ranked lowest of 7 countries when it comes to "quality of care"

So the question that should come to mind is: How do we reconcile living longer and productively when our care is deficient?  I think I know how. 

I know that we're a pretty health-conscious country.  I also know that we eat a lot less junk food than our southern neighbors.  But that's not all.  As a country, Canada ranks pretty high on public health consciousness.  I see it in my medical records business everyday as patients are retrieving their own personal medical histories from their records currently stored with us.  I also see it all around me with friends, family, acquaintances who all seem to be quite well informed about their health conditions, diet and exercise regimens, medications, etc.

After attending a keynote address by Google CEO, Eric Schmidt at the HIMMS conference in 2008, as he introduced Google Health and the search engine's usage for diagnosing health conditions.  He stated that that 94% of user reported health information and diagnoses on the internet was accurate.  Wow.  Talk about self-service health care!  Combine that statistic with the one put forth by the CIA World Factbook that states that Canada is, per capita, the 4th largest country of internet users (after Greenland, Netherlands and Antigua / Barbuda.  The US ranks 13th).  Now it starts to make sense.

Canadians are a health conscious population.  We are less inclined to put all of our faith in the health care system and we are more likely to be proactive in our health care management.  Part of being proactive is ensuring that our medical records are always available - especially to the patient, who is the only conduit to other care providers.  Moving towards secure electronic medical records (EMR) is certainly a step in the right direction.  Patient access and involvement should never be underestimated.