We are not alone…


Remember that scene from Lord of the Rings when Middle Earth lies in ruins, overrun by orcs, commanded by the sly and deceitful wizard Saruman?  Just when it looks like all is lost, Gandalf returns “at the turning of the tide” to join the battle and shore up the faltering shire folk.

That’s how I felt when I found out that we Telus users are not a lone voice calling out in the wilderness.   There are others with similar concerns about the secret, exclusionary, and divisive Data Sharing Agreement between the New Brunswick Medical Society and the Department of Health.

Benoit Essiambre in Moncton is one of many New Brunswickers who have been making use of the open source EMR software know as Oscar.   Check out his excellent EMR discussion forum “Oscar EMR New-Brunswick – Community”:  https://plus.google.com/u/0/communities/100772289658870223050?cfem=1

Benoit has been fighting a parallel but separate battle against New Brunswick’s unpopular and ill-fated provincial EMR monopoly.  He is more technologically savvy than I, and his musing on the current sad state of affairs in New Brunswick are highly informative.   Anyone with an interest in fostering and improving the state of medical records in this province should read what he has to say.

Here’s a sample, first published in April 2013, not long after the NBMS decreed its final solution.  His comments are well reasoned, fair, and balanced:

I have been investigating the choice of EMR for New-Brunswick medical practices and I find the government sponsored solution of Intrahealth through Velante a very usable system with loads of features and an efficient user interface however it is lacking in several aspects.

–  The price is very high. Over five years, the Velante solution costs more than $36 000 to doctors plus $16 000 to governments. That amounts to almost fifty thousands per doctor, a price that is excessive, especially when you consider that the US is moving towards free EMRs paid through advertisement such as Practice Fusion.

 $400/month or $24,000 upfront made sense ten years ago before the cloud computing revolution. Back then, server infrastructure was expensive to build and maintain and server software took much more time to write because the tools were rudimentary.  Companies that still charge high prices usually do it because they have large clients locked in their platform that have almost no choice to continue paying.

–  Placing all medical records in a single closed source, closed format technology also makes no sense in the context of a “One Patient, One Record” strategy. Doctors currently have small rooms in their practice to store paper records. Transferring the records to a closed digital service would be like letting a private company put a lock on all record rooms and allowing them to charge doctors for access. Giving monopolistic control over everyone’s digital records to a private company is a huge future cost risk. This risk is on top of the current high price per doctor. After paying fifty thousand dollars over 5 years to Velante, it will be difficult and costly to migrate the records out of the Intrahealth/Velante system and continued access will be subject to whatever price they set.

–  The Velante solution is based on older Microsoft technology. That is why using it with anything else than a Microsoft Windows computer, requires a Citrix layer. Citrix is a program that beams a desktop video feed from a windows computer running in a datacenter to a local computer. It is a band-aid solution, an additional link in the access chain and often a source of reliability problems. It exists mainly to compensate for the fact that Intrahealth is built on technology not compatible with Apple computers.  When I was at the Intrahealth demo, the demonstrator was running a Macbook without Apple software that was instead running Microsoft Windows. This gave the illusion of native compatibility with Apple products when in reality this is not the case.

The Intrahealth software has lots of features, but more features is not the direction software is evolving towards these days. Most software tends toward a more simplified feature set that lowers complexity. The fact that the Intrahealth solution relies on weeks of on site training to implement is definitely a red flag. We went to a Valente demo and the demonstrator was at multiple occasions unable to answer questions about how to perform some tasks in the system saying that the feature was supported and someone with more knowledge would help later.  If Velante’s staff has difficulty using their own system, how will doctors with limited time and resources to spend on learning it will be able to cope?

These statements have the ring of truth.  Anyone contemplating a jump from paper to electronic medical records should think long and hard about it before making a commitment.   Even more so if it leads down a path to somewhere you don’t want to go, and from which there is no turning back.

We must put an end to the EMR monopoly.   It was a poor concept from the outset, and the minuscule uptake by provincial physicians is evidence that it is not wanted or sustainable.  To persist is folly.

Back to the drawing board, boys.   Your show is definitely not ready for prime time.


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