Zen and the art of home electrical maintenance…


Last evening around 8:30, I performed my first useful act of the day.   I replaced a faulty dimmer switch in our kitchen.   How did I manage to get through an entire day without doing anything productive or useful?   Easy.   I attended the Annual General Meeting of the New Brunswick Medical Society.

At the meeting, some educational sessions were held, some speeches and reports were given, and a succession of doctors made motherhood statements about how the Society needs to be united and how we need to ensure that the NBMS serves the needs of all doctors.

All well and good.   No argument here.

The problem occurred when attention was turned to the topic of electronic medical records.   We heard some interesting statistics about how many doctors are using the Provincial EMR system offered by Velante, and some questionable (only because they have been wrong so many times before) projections about future conscripts to the system.   And we heard about how things are looking good for Velante now that the taxpayers are kicking in $1.5 million dollars a year to support the program.

Good for them.   I am happy that the subsidized program is doing what they wanted it to do.

It’s a different picture entirely for doctors who use one of the competing EMR packages.    These doctors, numbering well over 100 across the province, have been actively denied electronic access to their patients’ medical data.   This unfortunate state of affairs came about when, on June 13, 2013, the NBMS and the Province of New Brunswick signed a document entitled “Data Sharing Agreement.”    This document contains within it a provision that only one EMR vendor – the one marketed by Velante – will be permitted to interconnect with Department of Health databases.

This provision, his along with hefty government subsidies to Velante clients, creates a very uneven playing field for the other vendors.   It is, at its heart, an anti-competitive document.

Velante is ballyhooed as a “doctor-controlled” company, even though only two of the seven members of its board of directors are MDs.   So how well, as an offshoot of the NBMS, does it manage to hold to the principle of serving ALL NB doctors?

Answer:  it doesn’t.

Velante serves only its clients and the I.T. company Accreon, which owns 49 percent of Velante.  Early adopter of EMR technology and people who have recently chosen other EMR systems which better fit their needs are marginalized and their legitimate concerns are ignored.   The only time the NBMS is willing to give them the time of day, is when they are trying to lure them into switching vendors, as they dangle the bait of wads of taxpayer money.

You may think “But wouldn’t it be better if all NB doctors used the same EMR?”   This might appear to be an attractive option at first glance but there are a few problems with this concept.  Lets’s start with the three obvious ones.

First of all, not all NB doctors need the kind of EMR Velante is offering.    It is a “bells and whistles” system which is much more complex and expensive than many doctors need.    Second, the establishment of a single vendor and a province wide monopoly is bad for the consumer.   I have commented extensively on the reasons for this and will not repeat the rationale here.   Suffice it to say, when has a monopoly ever been good for the consumer? Thirdly, and most importantly, New Brunswick does not exist in a bubble.    Even if we were to have every doctor in the province using the same EMR, what happens when patients leave the province, or immigrate from other parts of Canada, or other countries?  Are their healthy records portable?  How do we manage the transfer of electronic data?

The solution is interoperability.

In order to have an optimally functional EMR system on a national and international basis, we need to ensure that data can be readily exchanged between different, competing EMR products.  This is where we are headed, and this is the essence of interoperability.   Numerous technology experts have commented that interoperability is the future, and we need to encourage and welcome it.   Patient health information is not owned by the EMR vendors and it is immoral and very likely illegal to refuse to permit the migration of data from one EMR product to another.   In other words, the days of the “walled silos” of isolated, patient information are coming to an end.    The EMR vendors know that that this is coming, and the forward-thinking ones are preparing for the end of proprietary, selfishly guarded databases.

Yet in New Brunswick, the NBMS and the Department of Health have colluded to prevent non-Velante users from having equal access to their patients’ data.

New Brunswickers need to recognize this.   The NBMS, in particular, needs a better vision for the future.   A corporate monopoly is short sighted.  We need a provincial EMR system which is inclusive and welcomes diversity and personal choice.

The naysayers have said “Oh, it’s so complicated to transfer information from one system to another.   It will never happen.   It’s too hard.”    While I agree, it may be difficult and expensive at this time to move data from one system to another, it is unlikely that this will persist indefinitely.   One has only to look around to see examples of technological advances which a decade or two ago seemed like science fiction, but are now reality.    Smart phones are one example.   Cars that park and drive themselves another.   There are thousands of examples of technological advances which the pessimists though could never happen which are now part of everyday life.

Interoperability between EMR products is not an unclimbable mountain, but neither is it a molehill.   It will be achieved, and it will happen in the not-too-distant future, but it requires effort, buy-in, and a can-do attitude.

Let’s make it happen.

I will be going to the NBMS Annual General Meeting again next year.  Next time I hope to be able to report, at day’s end, that more has been accomplished than fixing a light switch.


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