Running free…

Bolt

“And then one day you find ten years have got behind you.  No one told you when to run.  You missed the starting gun.”  Pink Floyd – “Time”

As New Brunswick continues to buck the worldwide trend for interoperability between health care information systems it seems appropriate to pause for a moment and consider how long this battle has been going on, and give credit to the early adopters of electronic medical records for recognizing the importance of various electronic systems being able to talk to each other.  Not only were early adopters first out of the blocks with new technology, in most cases they paid their own way, recognizing that improved handling of patient records would have important benefits for the their practice, and for the patients for whom they provide services.

Interoperability is the key to the establishment of a healthy EMR industry in New Brunswick.

Flash back to 2004, and this insightful report from the American College of Physicians:

Data Sharing

In 2014, everywhere there is progress dismantling information silos in favour of the free exchange of health care information.

Everywhere but here.

The New Brunswick provincial EMR program is stuck in a rut, jealously guarding access to information in order to further the monopolistic ambitions of a single vendor.  The proponents of the plan boast of the dozens of doctors who are said to have started to use their EMR product.   They have been able to achieve a modicum of success in a variety of ways:   1) handing out taxpayer money to offset their clients’ cost, and 2) forging a secret deal with the Department of Health, in order to cripple the competition.

Does that make for fair competition?

I think not!

Even I could run a faster 100 metres than Usain Bolt, if his ankles were shackled.

 

 

 

 

I Hate Blockers…

Blocker

Don’t get me wrong.   I like Dan Blocker.  He was my favourite character on the 1960’s TV show Bonanza.   Perhaps I have some sort of connection with big, lumbering, generally good-natured hicks who occasionally blow a gasket.  Can’t imagine why.   I also like beta blockers.   They are great for keeping the blood pressure down, and they prevent heart attacks.   Even Blue Blockers, the darling of the 1990’s infomercial sunglasses set, have their place, just not on my face.

But information blockers…. that’s another story.   In the EMR world, this term refers to I.T. companies that deliberately set out to inhibit the free exchange of information between medical professionals.    In New Brunswick, this practice is well illustrated by the egregious Data Sharing Agreement, which prevents me from getting proper access to my patients’ lab data.

If there was ever any doubt that the blocking of free exchange of health information was a bad idea, read on.  This is a huge issue in the United States, and the Senate appears to be on the verge of taking drastic action to penalize EMR vendors who seek to prevent information exchange.

From the June 2014 Draft Report from the Committee of Appropirations
United States Senate:

Information Blocking.—The Committee urges ONC [Office of the National Coordinantor for Health Information Technology] to use its certification program judiciously in order to ensure certified electronic health record technology [CEHRT] provides value to eligible hospitals, eligible providers and taxpayers. The Committee believes ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use. The Committee requests a detailed report from ONC regarding the extent of the information blocking problem, including an estimate on the number of vendors or eligible hospitals or providers who block information. This detailed report should also include a comprehensive strategy on how to address the information blocking issue.

The Data Sharing Agreement forged between the New Brunswick Medical Society and the Province of New Brunswick is a prime example of information blocking. If the U.S. Senate has it’s way, EMR companies like Velante and Intrahealth – were they to be conducting business in the U.S. – would be decertified.

It has come to this in the United States because things were done wrong in the first place.   EMR vendors were permitted to build isolated information silos which precluded the sharing of information.   Now they have a terrible mess which is going to be very expensive to fix.

In New Brunswick, the adoption of EMR technology lags behind both the United States and the rest of Canada.   Perhaps our Medical Society could learn from the mistakes of the past, and take steps to break down the barriers to information exchange.

The first step would be to abolish the Data Sharing Agreement.

How about it?

Zen and the art of home electrical maintenance…

Switch

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.

The escape clause…

Aston

The 2014 New Brunswick Medical Society Annual General Meeting has come and gone.  It has been a year since I presented a motion to the general membership which would require that the leadership of the Society not impede EMR user’s from having electronic access to their patients’ medical reports found in the Department of Health databanks.

So, what has happened since the membership voted overwhelmingly in favour of that motion?

The short answer is:  nothing.

Following the approval of the motion we entered a prolonged and unproductive period of dithering and blithering.   Here are some of the stumbling blocks along the long and winding road:

1. Non-Velante users are told the NBMS board needed time to determine how best to implement the resolution.

2.   We learn that the CEO of the NBMS signed a Data Sharing Agreement in June which prevents all non-Velante EMR users form electronically accessing patient data.  He denied the existence of this document at the 2013 Annual General Meeting, despite having signed it three months previously.

3.  The NBMS says the Minister of Health refuses to talk about renegotiating the exclusionary Data Sharing Agreement.

4.   The NBMS leadership reveals that Velante is not meeting enrollment predictions.  Their business plan is in jeopardy.

5.   Minister Flemming then says he is willing to discuss all the options, including renegotiating the Data Sharing Agreement.

6.  Mr. Flemming says maybe the province will take over the management of the EMR system, and void the Data Sharing Agreement by giving 180 days notice, as provided for in the agreement.

7.  Minister Flemming ends up doing nothing of the sort.

8.  The NBMS leadership transmogrifies the request for access to patient data to a request for financial help converting to the Velante system, despite that nobody was publicly asking for that, and it had nothing to do with the AGM motion.

9.  The NBMS negotiates a $1.5 million dollar per year clause in the Fee For Service contract with the Province, thereby pounding a bung into the sinking ship.   Thank you taxpayers!   (I thought I would say it, since nobody else did)

At the 2014 NBMS Annual General Meeting the leadership offers an explanation for why the year-old motion has gone precisely nowhere.  They go over much of what has been outlined above.   Then they release the ultimate bogeyman.  The Lawyer.   The membership is advised that the board has received legal counsel advising them that if they void the Data Sharing Agreement, they could be sued by the owners of the EMR package marketed by Velante, the New Zealand company, Intrahealth.  The spectre of bankruptcy for Velante and quite possibly the New Brunswick Medical Society is raised.  Everyone quivers in fear, and the annual review continues on another topic.

Now, this raises a couple of questions.   First of all, what the hell did the leadership think they were doing when they signed the cockamamie Data Sharing Agreement in the first place?  Why did it take a formal access to information request to bring the Agreement to light?

But, more importantly, how can you have an agreement, which says right there in black in white that it will remain in force indefinitely, which has an escape clause you can’t use because if you do, you will be sued and bankrupted?

It’s like buying a parachute with no ripcord, and not finding out about it until your plane has already augured-in and you are plummeting toward earth at terminal velocity.

It’s like James Bond buying an Aston Martin with an ejection seat, but finding out when it comes time to use it, that the car is a hardtop.

What a tangled web we weave.

 

 

 

No simple answers…

Answers

Despite what some salespeople and marketers may try to tell you, choosing and implementing an EMR which is a good fit for your practice is not easy.  It’s important to not be bullied or rushed into making a decision.   Time spent learning about the benefits and drawbacks of the different EMR systems is time well spent.    The following link to the “Canadian EMR” blog is a great place to start the learning process.

http://blog.canadianemr.ca/canadianemr/v-standards/

EMR Fun Facts…

Fun

Did you know that….

1.  The leadership of the New Brunswick Medical Society thinks an EMR monopoly is good for its members and does not want doctors to have any choice in which software they purchase.

2.  Doctors who don’t use EMR’s, or use something different than the one the NBMS supports, help to pay for doctors who have bought into the planned NBMS monopoly.

3.  The NBMS forged a “Data Sharing Agreement” last year which cripples the competition by denying electronic access to Department of Health databases.

4.  The recently approved Fee For Service contract for NB doctors includes a gift of $1,500,000 PER YEAR to the Provincial EMR program and that this money is only being used to support one EMR vendor, that being the one that is sold by Velante.

5.  Over 100 doctors in New Brunswick have been using electronic medical records for years, starting long before the advent of the Provincial EMR program.   Collectively they have poured hundreds of thousands  of dollars of their own money into advancing medical care in this province.  Hundreds of thousands of patients have benefitted from these forward-thinking individuals.

6.  New Brunswick is the only province saddled with a Data Sharing Agreement which limits the access of doctors to their patient’s electronic lab and diagnostic imaging reports.

7.  Doctors using EMR packages like Practice Solutions or Oscar LOVE their EMRs, and don’t want to change from something which is working very well to something which has an unproven track record.

8.  Monopolies, like the one Velante seeks to establish for NB EMR users, are bad for the consumer, stifle innovation, and lead to vendor complacency about customer service.   They also tend to drive up costs by eliminating any need to compete in a free and open marketplace.

9.  Uptake of the Provincial EMR program has been very poor, particularly among doctors who have to pay their own way.  Salaried doctors, who are employees of the Department of Health, get their EMR for “free,” which means the taxpayers pay the whole shot.

10.  The leadership of the NBMS are telling people they are trying to help early adopters of EMR technology.   What they are in fact doing is trying to coerce them into switching to their preferred EMR vendor.   We like what we have now, we don’t intend to switch, and what they are doing is actually the opposite of helpful.   If they really wanted to help, they would obey the will of the membership, and abolish the Data Sharing Agreement.