BY NORM TOLLINSKY

Managing a busy medical practice, keeping pace with an ever-expanding knowledge base and having a personal life is enough of a challenge. Selecting an electronic medical record application is one task most doctors would rather avoid.

There are a few exceptions. Dr. David Topps, director of eLearning at the Northern Ontario School of Medicine (NOSM) and a member of Sudbury’s City of Lakes Family Health Team, developed an interest in computer technology in the course of a 15-year career as a GP and educator in Alberta.

Having played a key role in the selection and deployment of an electronic medical record system for 80 plus concurrent users at the University of Calgary’s Department of Family Medicine prior to joining NOSM, he was more than qualified to help his Sudbury family health team select a system.

Physicians thinking of joining the digital revolution should start off by researching a vendor’s track record.

“There’s a lot of product on the market and it’s quite likely that you’ll see a significant amount of consolidation in the next two to four years,” he said. “In Alberta, we went from 54 vendors down to 20.

“Having a vendor disappear on you can be a huge issue,” warned Topps. “You want to make sure that you can access your data and move it to a different system if the company goes belly up.”

Make sure you have a schema or an index of how the data is put together so it’s retrievable and exportable, and get assurances in writing, he advised.

Topps encourages physicians to take the time to identify their requirements and expectations before evaluating competing systems. Once the list of vendors has been whittled down to two or three finalists, he urges physicians to ask for references and talk to users.

“You want to have your staff talk to their staff. Find out what they like and what they don’t like.”

Involving staff in the process is important to ease the change management process, said Topps.

“There’s a lot of talk about efficiencies and cost savings and staff tend to jump to the conclusion that they’ll lose their jobs. Personally, I’ve never seen anyone lose their job as a result of an EMR implementation.”

Physicians should make a point about asking how vendors license their software. The vendor’s licensing policy should accommodate medical students, residents and training nurse practitioners who will require unique IDs to access the system.

“If they ding you for every student or resident, the cost can really jump.”

One of the most important decisions physicians will have to make is whether to go with a standalone system or an Application Service Provider (ASP) model. In a standalone system, the server and the data are located in the physician’s office. In an ASP model, they are located at a clinic, a local hospital or at a Ministry of Health and Long-Term Care data centre in Toronto.

Physicians choosing the ASP option don’t have to worry about backup and security, but are dependent on the Smart Systems for Health Agency’s ONE Network.

“If the connection goes down, you’re out of luck,” said Topps.

“The other problem is that not everyone is comfortable with the government having their medical records. It doesn’t matter how many times they say it’s confidential. Some of your patients are going to say, ‘I don’t think so. Look at Winners. They said the data was secure and I had to go and change all of my credit cards.’”

On the other hand, physicians choosing a standalone system have to take responsibility for backing up their system and storing their data offsite.

“If there’s a fire, you don’t want to lose all of your data,” warned Topps.

Recognizing the danger of relying on network availability, some vendors are developing hybrid ASP solutions with mirrored storage onsite so physicians can continue to access data and see patients if the network goes down.

It’s a no-brainer for physicians starting a practice to go electronic from day one, but how should a physician with an established practice and an office full of paper records manage the transition?

Topps recommends picking a date and going electronic from that point forward.
Scanning back records into the system would take forever, he said.

“The best thing to do is to start with your thick file patients – your frequent flyers – and make a one-page summary of the key points. Take one or two home every evening, and by the end of the year, you’ll have 70 per cent of them done.”