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.

 

 

 

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A taxing situation…

Galleon

Did you ever wonder why the New Brunswick flag has a picture of a slave galley on it?    It should be fairly obvious, two weeks after Tax Freedom Day.  If not, think about it.  After a while it should start to make perfect sense.

We are all rowing hard to keep up with the myriad of government taxes required to keep the ship of state afloat.   Federal income tax, province income tax, harmonized sales tax, import tax, property tax, fuel tax… it just goes on an on.  Come to think of it, given the stagnant (at best) New Brunswick economy, maybe we should redesign the flag, and replace the oars with bilge pumps.   It’s a bit of a stretch to imagine the NB ship of state making forward progress, but perhaps with a few good cracks of the whip, we can at least keep our feet dry.

Nobody enjoys paying tax, but taxation is a necessary evil… most of the time.   Taxes are needed to pay for what we have come to believe to be essential services.   But, interestingly, taxes even help doctors – among the most well-paid people around – to pay for their Velante EMR system.    Every year from now on, taxpayers will be coughing up $1,500,000 to help keep the bilges dry at the old Velante EMR works, thanks to the new fee for service contract negotiated by the NBMS and the Province.

Outside of the government sanctioned and funded provincial EMR system, there are others who shun the government handouts, and market their own EMR solutions by promoting it on its merits.   A novel thought, and an approach which should be commended.   I heard one of these industrious visionaries on the radio this morning.

Local I.T. entrepreneur Tristan Rutter and his New Brunswick company Populus Global Solutions have made a big splash in health care in four Caribbean countries with a fully-functional but reasonably priced EMR product.   This homegrown product has run into some snags in New Brunswick – not surprisingly – as the NBMS continues to pursue its obsession with an EMR monopoly, while the provincial government washes its hands of the matter.

You can listen to Mr. Rutter here:

 

The EMR debate, it seems, is not over.

Far from it.

 

 

 

A fresh start…

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I don’t know about you, but I for one am sick and tired of the defeatist approach to the concept of multiple EMR vendors in this province.   Sometimes it seems that the parade of excuses goes on forever.

We can do without the negative thinking.  Pessimists and nay-sayers need to stop obstructing progress and make way for others with vision and a “can do” attitude.

There are those who believe EMR vendor’s just can’t make it in this province unless they sign up 500 clients and have a secret contract to hobble the competition.  These same people note that there are fifteen vendors currently supplying doctors in this province.    Even though these vendors only have a handful of clients, they seem to be doing just fine, despite being undermined by the Data Sharing Agreement.   Velante’s claim that their product can only survive by cutting the legs out from under the competition speaks volumes to the weakness of their business plan.

A well planned business should stand on it’s own two legs, and not need to be propped up by government handouts and secret deals which foul the waters for competitors.

Play fair or get off the field.

Nobody wanted the Velante system to fail, but fail it has.

The Minister of Health says the province may step in to bail out the sinking Velante vessel.  Ironically, that may result in another plan just as expensive and centralized as the current one which will compel doctors to use a “one size fits all” EMR.   That’s a scenario which is to be avoided.

Here is my plan:  It’s cost effective, provides for freedom of choice for doctors, and will improve health care outcomes.

  • Admit the Velante plan has failed.   Let’s cut our losses and disband or remodel the company.  Cut Accreon out of it.   Intrahealth should be able to continue to provide support to the 34 doctors currently using their software.
  • Tear up the Data Sharing Agreement.
  • Allow any vendor who is prepared to pay the cost of interconnecting with DOH computers to do so.   Any vendor who cannot pay the cost can still function under current conditions, just as they have been all along.
  • Establish a system of “Sentinals.”   By this I mean a group of doctors selected from all parts of New Brunswick, who are advanced EMR users, each with practices of over 2000 patients, who are making full use of their EMR’s including the use of standard ICD-9 disease coding.
  •  Employ a provincial Health Statistician whose job it will be to collect data from the Sentinel physicians in order to provide statistics on disease prevalence and control, medication use, immunization rates, and utilization of health care resources – all on a quarterly basis.   With even a dozen doctors participating, you will have a sample of 24,000 or more, which should be adequate to provide reliable figures for the province to use.
  • Sentinal physicians would receive a monthly stipend to compensate them for the additional time and effort required to keep their records in a state which permits easy data mining.

This plan would accomplish several important goals:

  • Physicians would be free to choose the EMR which best suits their needs, or continue to use a paper based system.   Over the next 10 or 20 years, the proportion of doctors using EMRs is going to grow with out any help, as new doctors don’t want paper charts, and are part of a more tech-savvy generation.
  • Physicians could choose an EMR which interconnects with DOH databases if they wish, or a simpler system – which is likely to be the choice of many specialists – with more limited capabilities.
  •  Physicians who do not interconnect can still access the provincial EHR, as they can now, using the existing portal.
  • The Department of Health would benefit from access to data from a representative sample of the population, which if designed properly by a competent statistician, would give very accurate and usable information.
  • Early adopters could take on the role they should have had all along, as the greatest supporters and promoters of EMR technology.
  • The I.T. industry would receive a boost by having the opportunity to write software packages which could perform functions such as data migration, for patients who move from another province and are able to bring their electronic medical file with them.   We will need people to develop apps and provide security and data encryption programs for tablets and laptops, maybe even smartphones.
  • The only downside to this plan is that Accreon would lose one of its cash cows.   Even this might not be much of a loss, as that cow is currently producing sour milk, and not much of it.

This system, implemented properly would realize tremendous savings to the province while still providing the data the department needs.   Doctor buy-in and satisfaction would rocket upward.   The I.T. sector for small local players would get a huge boost.

The time has come for NB EMR 2.0.

Are you in, or out?

In case you missed it…

Nagra

CBC Fredericton’s Information Morning Host Terry Seguin speaks with Dr. Doug Varty about doctors’ frustrations with the provincial EMR program.

Tristan Rutter, CEO of Populus Global Solutions weighs in of the EMR debate and offers his expert opinion on what ails the provincial program.   Following that, Information Morning Host Terry Seguin switches pace and quizzes NBMS/Velante CEO Anthony Knight about why his business plan has fallen so far short of expectations. 

CBC TV’s Harry Forestell speaks with NBMS/Velante CEO Anthony Knight about the status of the New Brunswick Medical Society’s foray into the I.T. business.

CBC Fredericton’s Information Morning Host Terry Seguin speaks with New Brunswick Minister of Health Ted Flemming for his take on how the provincial program has unfolded, and what the future may have in store for the troubled venture.

A bright sunshiny day…

Bread

Great news!  Way better than sliced bread.

The Minister of Health is willing to renegotiate the exclusive Data Sharing Agreement which was secretly drawn up and signed last summer.

This paves the way for wonderful EMR choices like Practice Solutions to fully integrate with the Provincial program, and signals the beginning of the end for the ill-considered and unpopular monopoly which had been the lone entrée at New Brunswick’s single-item EMR buffet.

You can read about it here:  Time For a Better Deal

Used and abused…

Image

I had a bit of an epiphany the other day as I drove along one of New Brunswick’s back roads.   An epiphany that was every bit as much as a jolt as hitting one of our famous wheel-swallowing potholes.

What if I have got it all wrong?

What if the CEO of the NBMS is not a conniving, self-serving, duplicitous pawn of I.T. profiteers?

What if the Minster of Health really is as heartless and mean-spirited as the leadership of the NBMS implied last year?

What if I, and others like me who are shut out by New Brunswick’s asinine EMR monopoly, am simply a pawn in a vicious game designed to weaken the province’s doctors and bankrupt their professional society?

It could be, and here’s why.

The New Brunswick Medical Society, like all provincial medical societies, has professed an interest in developing a provincial electronic medical program for years.    They have seen how others in other jurisdictions have failed, running up enormous costs with very little to show for it.  Accordingly, until recently they had proceeded slowly and with appropriate caution.

Other provincial health departments have been stung with the heavy cost of implementing a universal EMR program, while simultaneously deriving little benefit in terms of lower health care costs.

What if the Minister of Health, recognizing that there is federal money available from the Canada Health Infoway, decided to use that money to bait a trap for the hated NBMS?   Having seen the disasters that had befallen provincial governments in places like Ontario, if he could somehow convince the NBMS that they should lead the way in the implementation of a provincial EMR program, then sweeten the deal with federal bucks, convince naive doctors that they should select a sole EMR vendor whose product is almost guaranteed to be unpopular with the bulk of NB doctors, then encourage the NBMS to buy a nice new office building to house all the sales, support, and marketing folk, and take out a huge bank loan to support it all… well, you can see where this is going to end up.

This is precisely what has happened.   The NBMS selected an EMR vendor which not a single New Brunswick doctor was using, and simultaneously slammed the door in the faces of early adopters of systems like Practice Solutions, Nightengale, Oscar, Wolf, and other popular choices.    They bought the new palace on Alison Blvd (then couldn’t sell the old place on York St), took out a huge bank loan, and now are scrambling to find a way to pay off their debts.

NBMS member fees have gone up substantially in the past two years to fund this folly.

As an unexpected bonus, in the mind of the minister, are people like me.   Ostracized by our own professional organization.  Shunned and ignored by the leadership.    Now forced into a role we did not want, fifth columnists fighting those who should be providing wise leadership.   I would be surprised if the Minister can sleep at night, snorting and chuckling gleefully at the prospect of doctors infighting.

This is a perfect storm for the Minister of Health.   The NBMS took the bait and now are saddled with a multimillion dollar boondoggle which is going to bankrupt the Society.    A monopoly EMR, which if it survives, will bleed doctors to feed Accreon corporate profits for years to come in a never-ending web of servitude from which there can be no escape.

I have to hand it to Ted Flemming.   I didn’t think he was this smart.  But he is.  He is a master puppeteer, and he has NBMS CEO Anthony Knight dancing at the end of his strings like a drunken Pinocchio.

Now, having exhausted all reasonable means to achieve justice for early adopters of EMR technology, having sent letters to the president of the NBMS which have gone unanswered, having been lied to by the CEO of the New Brunswick Medical Society, having been manipulated by the Minister of Health to undermine my colleagues, having, in short, been used and abused by almost everyone involved in this sad, sad state of affairs, I am saying now, enough.   I am done.

Let the NBMS carry on with their failed, ill-conceived EMR monopoly.   Let those doctors who wish, sign on to the new program.  I will continue with my EMR of choice.  NBMS fees will continue for rise and there will be great gnashing of teeth when people realize what a terrible mistake the Velante program has been.   But by then it will be too late.    Accreon will buy out the NBMS share in Velante and save the Society from bankruptcy, but leave it crippled and weak.   Doctors who have bought into the Velante solution will be enslaved by it.   User fees will rise and technical support will all but vanish.

And there won’t be a damn thing anyone can do about it.

In closing I will say to the leadership of the New Brunswick Medical Society, Velante, Accreon, and the Minister of Health, it has been a slice.   The combination of duplicity, ignorance, greed, and callousness has been truly mind boggling.   You deserve each other.

The real losers in this debacle are the people of New Brunswick.    Handled properly and honestly, a provincial EMR system could have been a thing of beauty, something which would improve patient care and reduce health care costs.

Sadly, in New Brunswick, it ain’t gonna happen.