Christmas is coming…

screen-shot-2016-11-08-at-11-33-58-am

Hi! I’ve been away for a bit, but this is too shocking not to pass along. I’ve always been a proponent of choosing health care software carefully, but out in British Columbia, they appear to have hit a new low.  Apparently, in Nanaimo, the EHR system chosen by the local health authority is SO BAD they have to pay doctors to use it.

Doctors will pay top dollar to use a high-end EMR that improves patient care and streamlines routine tasks, they will begrudgingly accept a second-line system (like the one being flogged by the NBMS) if user fees are subsidized by their peers but, apparently, you really do have to pay people to use one that is truly abysmal.

See for yourselves…

http://www.hospitalemrandehr.com/2016/11/07/health-system-pays-docs-to-use-cerner-ehr/

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

A Populus Global Solution…

Stetho

Local IT company Populus Global Solutions and it’s electronic medical record system is taking the world – or parts of it – by storm.   It’s being sold on its own merits to a variety of Caribbean countries and looking to expand into even more countries.  It’s a refreshing approach: popular, rapidly implemented, on budget, and on schedule.   Most importantly, they don’t rely on secret exclusionary deals to get a leg up on competitors.

Your can read about it here:

In New Brunswick it’s clearly time to rethink our provincial EMR monopoly.   Not just because Accreon is bailing out of Velante.  Not just because the existing EMR program is costing a fortune.   Not just because the uptake remains questionable despite fire-sale prices and high-pressure sales pitches.

We need to reconsider what we are doing with EMRs in New Brunswick because the fundamental concept of an exclusionary monopoly – such as that forged by Velante and the Provincial government – is wrongheaded and lacking in vision.

We don’t need a single EMR vendor jammed down the unwilling gullets of an unwilling clientele.   We need choice.  We need a product which fits the needs of the customer.

It’s not about profit.  It’s not about lining the pockets of IT consultants.   It’s about using appropriate technology to improve the health of New Brunswickers.

That’s the only bottom line that matters.

 

We’re Number 1…

Podium

Congratulations, New Brunswick, 58 percent of your doctors cite lack of “compatibility with other electronic systems” as a barrier to accessing electronic medical records.   Coincidentally (or not), we are the only province with an ironically named “Data Sharing Agreement” which severely limits access to patient data for a large proportion of EMR users.

A full 40% of New Brunswick physicians said access to electronic records was “unsatisfactory,” much higher than even Newfoundland, which came in second with 30.7%.  Only 4% of New Brunswick doctors said access was “excellent,” ranking us second worst in the country.  Only Quebec scored lower with 3.6%.

Time to smarten up and get with the program, New Brunswick.   Information silos are NOT helpful.   Interoperability is the way of the future.

Abolish the Data Sharing Agreement now!

More information from the latest National Physician Survey is available here:  NPS 2014

View From The Top…

Canadian Medical Association President Dr. Chris Simpson wrote this excellent commentary for “Future Practice,” the CMA publication which examines issues related to technology and medicine.   Clearly he supports the concepts of interoperability between EMR and EHR systems, and finding a good fit between individual physicians and the EMR products currently available.

Have a read.   It seems very straightforward.

Unfortunately, New Brunswick remains mired in a regressive single-vendor environment, promoted jointly by the Department of Health and the New Brunswick Medical Society.

New Brunswick remains the only jurisdiction in the country which bans all but one EMR vendor from digitally linking to provincial health information databases.   Patients, doctors, and the I.T. industry are all losers in this regrettable and embarrassing morass.

Kudos to Dr. Simpson for his progressive and intelligent approach.

Building a better EMR

 

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?