Gotcha!

trap!

More thoughtful analysis of the American EMR experience courtesy of the KevinMD.com website.

It is becoming apparent that more and more EMR users are finding themselves trapped with an EMR that they either did not want, or that they signed up for only because of fire sale prices enabled by government subsidization.

Hmmmm… sounds familiar…

The result is that customer satisfaction is in freefall.

Yet more evidence that the New Brunswick approach of “my way or the highway” is wrong.

Dead wrong.

Read on to find out why, and how we could do things differently here:

I Despise My EHR, But I’m Still Using It

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The Holy Grail…

Bunny

As the New Brunswick EMR dream of “One Patient, One Record” continues to unravel and costs skyrocket there is growing recognition outside of the realm of the New Brunswick Medical Society that the key to successful and meaningful use of electronic medical records lies in getting disparate systems to talk to each other. It is abundantly clear that we need a variety of EMR software packages to fit a variety of physician needs, and that these products need to be able to exchange data with a minimum of fuss and bother.

Achieving this might be akin to finding the Holy Grail, at least according to a recent article by Dr. Eric Cadesky of Vancouver, published in the June 2015 edition of “Future Practice.” The analogy fits to a degree, but a better analogy might be finding the Rosetta Stone, the original “interoperability engine.”

You can read the full article here: Interoperability: The Holy Grail of EMR’s

The message is clear, and there is a rising tide of voices opposed to the suppression of information sharing as exemplified by the curiously named Data Sharing Agreement between the New Brunswick government and the New Brunswick Medical Society.

Time to step back and rethink the plan. Blindly pursuing a model which relies on a single EMR vendor runs counter to what is best for patients and the medical community. We need interoperability, and the sooner the better. If we are to make any progress toward that goal, we need buy-in on the part of the NBMS and the New Brunswick government.

Sadly, we have neither.

The future is now…

app

Yesterday was a great day for the dozens of Telus EMR users in New Brunswick and for their estimated 100,000 plus patients.   The most recent software upgrade has some innovative advances in functionality and convenience but, most importantly, Telus clients now can have instant, continually updated access to their EMR data anywhere, anytime.

It’s all done by simply downloading an app which allows the user’s phone to be linked to the office EMR.  With the new software, Telus clients can access their patient data, office schedule, and contact information in seconds via a secure, password-protected encrypted portal.

As far as I know, no other vendor in the province has anything like this, which is a shame, because it is definitely going to make doctors’ lives a whole lot easier.   And it is only the beginning.

Thinking about buying an EMR system?   As the saying goes “Choose Wisely.”  It’s a major investment of time and money, and you want to go with a company that can deliver the goods.

If you are interested in what Telus has to offer, this is a good starting point:  https://www.telushealth.co/health-solutions/electronic-medical-records/overview/?redirect=beta

And here is a link to the App Store:  https://itunes.apple.com/ca/app/telus-emr-mobile/id884824587?mt=8

Think this is the final piece of the EMR puzzle that you needed to take the plunge?  Still not convinced?  Why not get a demo of the software.  You won’t be disappointed!   http://www.telushealth.com/emrsolutionportfolio/default.aspx?gclid=Cj0KEQjwmqyqBRC7zKnO_f6iodcBEiQA9T996ECtTdB6N8LnAuxc9mqgvqLYYKEasX6h5I1q-8IJnkgaAiXN8P8HAQ

Now, I’ve been saving the best for last.

Other EMR vendors have been known to jealously guard and protect their turf from competitors.  One even signed a secret deal with the government preventing doctors form accessing their patients’ medical information!

Telus is actively promoting and developing technology which allows different EMR systems to talk to each other, making efficient, straightforward exchange of information a reality.  In the EMR business, it’s known as interoperability.    It’s more than just a buzzword.  It’s the way of the future.

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?

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.