EMRs enable powerful functionality

Vendors of electronic medical record (EMR) software for physician practices in Canada have tended to be smaller, regional players with applications tailored to the individual requirements of provincial health ministries across the country.

All that changed in 2004 when the Canadian Medical Association (CMA) subsidiary, Practice Solutions, purchased Cambridge, Ontario-based HealthCare Software Inc., developers of NetMedical.

CMA-owned Practice Solutions was launched 12 years ago to assist physicians across Canada with practice management and technology.

"We started off providing our members with consulting services to help them organize their practice, negotiate a lease, hire staff and select an EMR," said Robert Thorpe, president of Practice Solutions Software Inc. "When we were doing EMR selection and readiness seminars, doctors would tell us, ‘Why don't you just tell us which one to pick?
We don't have the time.' That prompted us to get into the business ourselves.

"The other reason was we knew that some of the vendors we were recommending weren't well financed and we felt that doctors deserved to have an EMR partner that was in it for the long run."

The CMA looked at developing a solution itself, partnering with a company to build one and simply buying an existing EMR vendor. HealthCare Software was originally overlooked because its applications had traditionally run exclusively on MacIntosh computers. The CMA subsequently took a closer look when HealthCare Software rewrote its applications to operate in both Mac and PC environments.

Growth

Since purchasing the company in November 2004, NetMedical has been rebranded as Practice Solutions EMR and adapted to meet the requirements of provincial health ministries from New Brunswick to British Columbia. Its Cambridge head office has grown from 23 to 100 employees and sales have increased at a rate of 40 to 50 per cent per year.

"The product was very well received in the marketplace," said Thorpe. "Physicians who see it understand it very quickly. There's a quick learning curve and a very happy install base. We were told that while we were negotiating, but we measured it after we bought the company and it was true."

Client surveys today show an overall satisfaction rate of 8.13 out of 10 - "that's a very high rating," he said.

There are four possible configurations for EMR deployments, explained Thorpe.
Physicians can elect to have a server and data storage in their office; they can link up two or more clinics with the server in one of them; they can have a local hospital serve as the host, or they can opt for an Application Service Provider (ASP) model and communicate over the ONE Network to Smart Systems for Health Agency's (SSHA) data centre in Toronto.

ASP model

The ASP model is the easiest way to make patient records accessible to hospital ERs and other health-care providers and relieves physicians of responsibility for backup and security, but if the network goes down, the physicians affected lose access to their data.

"You can have a room full of patients in your waiting room and others in your examination rooms wearing paper gowns and not be able to get at their records," said Thorpe. "And you don't know who else is coming in today because you can't see your schedule."

To get around the problem, Practice Solutions will offer a business continuity server that will synch up with the data centre server and allow physicians to continue working while the network is down.

"It will be an option, but it's going to be a strongly recommended option," said Steve Horodziejczyk, Practice Solutions' Sudbury-based account manager.

Until recently, xwave Healthcare, a division of Bell Aliant, was the only electronic medical record vendor recognized by Ontario MD as an ASP provider, but two additional vendors, including Practice Solutions, were selected last year.

Bird's eye view

The Practice Solutions EMR provides the physician with a bird's eye view of each patient in what's called a Cumulative Patient Profile. In one single screen view, the physician is able to see the patient's family history, current problem list, a history of past health, allergies and current treatments and medications.

Drilling down to a complete history of treatments and medications opens a running timeline, indicating dosage changes and reactions.

Prescribing a medication generates a neatly typed prescription form that the physician prints out and hands to the patient. Down the road, when pharmacists agree to accept electronic signatures, the system will transmit the prescription directly to the patient's pharmacy.

For every medication prescribed, Practice Solutions EMR automatically checks for drug interactions by referencing the First DataBank.

To order lab tests, the physician calls up an electronic form, checks off the tests required and prints it out. The results are returned to the physician electronically and filed in the patient's record once they are reviewed.

"Double-clicking on any result with a numeric value generates a graph showing all of the data points of previous tests along a timeline," said Horodziejczyk. "It also shows you the normal range and correlates the data with the medications the patient was on at the time of each test. A lot of patients like to show their patients graphs of their blood pressure and cholesterol so they can see how they're progressing."

Referral notes to specialists can be quickly generated using templates that can be coded to automatically include a patient profile or a list of active treatments so the specialist has some background.

Searches

Powerful search functionality allows the physician to generate letters to all of his or her patients taking a medication that has been delisted. Similarly, reminder letters can be sent to all patients who haven't had a mammogram in six months or to all patients identified as smokers.

Electronic medical record software also helps family health team physicians claim cash bonuses for achieving prescribed preventative care milestones.

"Without an EMR, it would be very, very difficult to qualify for these bonuses because of the time and effort required to collect the statistics," said Horodziejczyk. Reports generated by the EMR identify the number of patients who should have had a flu shot, mammogram or fecal occult blood test, and how many were actually done.

When Practice Solutions purchased HealthCare Software in 2004, there were 2,000 users, but only 200 using the company's EMR module. Today, Practice Solutions has 1,300 physicians using its EMR application.

The next few years will see tremendous growth in the adoption of EMR technology, predicted Thorpe. Adoption rates in North America are still hovering in the 10 to 20 per cent range, while in Europe, 80 to 90 per cent of physicians have already made the move.

www.practicesolutions.ca