The age of persuasion…

Herding Cats

Historically, certain large corporations and autocratic governments have been fond of a persuasive technique known as “The Big Lie.”   Essentially, you hire cabal of P.R. flacks to repeat what you want people to believe over, and over, and over, until they start to believe it.

It’s a technique which is deceptive, disreputable, underhanded… and effective.   AND, it’s being used right here in New Brunswick to shore up the failing provincial EMR program.

Despite the fact that Velante and the NBMS have only one fifth of the doctors they had hoped would be signed on to the monopoly EMR program, they are trumpeting success, and inciting others to jump on the bandwagon.

Well, my boastful friends, you might want to check the bandwagon’s wheels.   I think you have a flat.

While you are bragging about your Pyrrhic victory, you are emptying the bank account of our membership fees to pay for your P.R. and I.T. people, and ignoring the fact that apart from a relative few conscripts, doctors don’t like your EMR.  And they are voting with their feet.

Here’s an example of what has been foisted on us by proponents of the NB EMR monopoly.   Their text has been italicized for emphasis.   This was posted by Accreon, the money-making partner in the NBMS/Accreon union which gave birth to Velante.

Posted by Accreon   |   December 9, 2013

“Physicians in New Brunswick (Canada) now have access to an electronic medical record (EMR) solution that is integrated with the government’s provincial electronic health record (EHR).  This is a significant achievement.”  

It is significant because VelanteNBMS have slammed the door on a large number of doctors in New Brunsick with their “My Way or the Highway” philosophy.   Early adopters of EMR technology, some of whom are using software which is equal or superior to the Velante offering, have been shunned, ostracized, and denied the option to integrate with the provincial EMR by a secret data sharing contract they collaborated upon.  Please note:  “significant” is not synonymous with “desirable.”

“What does it mean to be integrated with the government’s electronic health record?

Simply put, doctors are part of a network of interconnected providers.  From the first day a physician is up and running with the NB EMR, he or she has electronic access to lab and other test results for all their patients, regardless at which hospital the test was completed.  As more and more physicians begin to use the NB EMR, doctors will be able to refer patients to other doctors electronically for consults, forwarding only the relevant parts of the patient chart to the consulting physician.  In turn, the consulting physician will be able to provide his or her report to the referring physician electronically, automatically updating the patient’s chart in the EMR.”

Simply put, doctors are your gateway to health.   We all have access to lab results and diagnostic imaging reports.    We have always had this.  I use Telus Health and I have been electronically consulting other physicians for three and a half years with my EMR.    The Velante plan simply creates two classes of doctors.   Those who toe the party line and buy into Velante, and those who exercise their (?temporary) freedom of choice to choose the EMR which best suits their needs.

Velante is anti-choice.

But they are happy to take your money.

“Once the provincial Drug Information System becomes available, all prescriptions ordered and dispensed will be available to the doctor through their EMR.  And for the Department of Health, a single integrated EMR substantially controls the cost to NB for building and maintaining interfaces between multiple software packages.”

I get the drug database idea.   I should say, I got it.  Have had it for three and a half years.  Never mind the fact that at least one EMR competitor has offered to pay all startup and ongoing costs of interconnecting with the Department of Health computers.   Apparently, the braintrust at Velante thinks you SHOULD look a gift horse in the mouth.

“While other provinces did get an earlier start with their introduction of electronic medical records, few achieved this type of integration on Day 1.  How is a cash-strapped province like New Brunswick able to pull this off?  The answer lies in being results-oriented, collaborative and a bit creative.”

Well, in fact, Velante doesn’t have this type of integration either.   They hope for it.  But it is not reality, and it remains to be seen if it will ever happen as promised.    As far a how NB has managed to sign on the few doctors it has to the provincial EMR, the answer is, sweet talk, federal grants, and bending the rules.  Collaborative?  Don’t make me laugh.   Collaboration is not in the Velante lexicon.

“In 2012, the provincial government assigned responsibility for launching NB’s EMR Program to the New Brunswick Medical Society (NBMS).  With the involvement of the Department of Health (DOH), NBMS, through its EMR delivery company, Velante, conducted a rigorous procurement process based on national standards for EMR solutions, that saw 18 responses to the public Request for Proposal process.  The process of selecting the EMR involved physicians, technical and software experts, and government partners.  In the end, a single EMR product was selected.”

Translation:  They chose one of several good systems and then excluded all others in the interest on making a profit for Accreon.   Physician preference, as clearly demonstrated by the early adopters, was not a consideration.

“At the same time, NBMS was working with the DOH to establish the integration components and build the interfaces and processes necessary to ensure a valuable software solution for doctors.  Fast-forward about 13 months and the NB EMR Program’s first group of participating physicians has gone live.”

Whatever that means.    Meanwhile Velante and the NBMS are in cahoots, working diligently to ensure that the doctors who laid the real groundwork for a physician-friendly, usable provincial EMR system “go dead.”   Is the system implemented “valuable” to doctors?  I think not.  Valuable to Velante, mais oui!

“The assignment of this program to NBMS has enabled New Brunswick to implement an EMR program with minimal initial investment from the provincial government.  This is a great achievement by NBMS and the Province, and a testament to the efficacy of the Government’s decision to assign responsibility to them.”

In other words, the province gets to freeload off the backs of doctors, as the NBMS drains it’s coffers paying Velante employees.  Meanwhile doctors – many of them completely unreceptive to Velate pitchmen – continue to pay for the program through their annual membership fees.   Great deal for the Department of Health.  Great deal for Velante.  For doctors… meh…

“And doctors are signing on.”

At least 110 of 1600 in the province have shown some interest in the scheme.   Lured by federal subsidies and sweetheart deals.

Sixteen are actually using Velante’s software.

Sixteen.   After a year of intensely marketing their monopoly, even offering to break their own rules about not funding the expensive process of moving data from the old EMR to their product.  That’s the best they can do.

“To date, approximately 450 physicians, nurses and medical administrative staff are enrolled in the program.  These leaders will lead the way having bought into a vision that is now a reality.  It is anticipated that their colleagues will rapidly join them in using the physician-selected solution.”

I repeat.   Sixteen are actually using the software.  Don’t count your chickens before they are hatched.   Velante had hoped to have 600 doctors (note: not nurses and admin staff) committed to their program by now.  They are miles short of the goal.  Plus, the real leaders are those who made a conscious choice of EMR’s and paid for it on their own dime, not those who were cajoled, lured, and bullied into accepting the unpopular Velante EMR vendor.

Make no mistake about it.   The monopoly was not established by a reasonable consensus process.   The monopoly was established by a small number of well-placed NBMS members and staff, and solidified with the secret exclusionary Data Sharing Agreement.  No doubt Accreon played a significant role in shutting out all other software vendors.

What the smiling Accreon cheerleaders seem to have forgotten is that, like cats, physicians are strong-willed, independent, intelligent, and not easily controlled.

And, though we may at times seem docile and content, when required, the claws can come out.

Good luck with the herding.

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