Physician prescribes EMR for practice

A family physician in Toronto has rolled out electronic medical records to reduce errors, track chronic illnesses and ultimately improve patient care.

Dr. Michelle Greiver has been practicing medicine for 20 years, and sees 20 to 40 patients every day. Legally, she’s required to keep patient records at least 10 years. “We’re starting to have a lot of problems with patient care because sometimes you can’t find a chart if it’s been misfiled,” she said. “Paper volume is unbelievable and as a result my staff spends a ton of time managing paper.”

Not only does this increase the potential for mistakes, she said, it’s also hard to track chronic illnesses such as diabetes – and she’s too busy to accept any new patients.

Greiver became a member of the Ontario Family Health Network (FHN), a group of nine doctors in seven offices across Toronto, in order to receive provincial funding for IT, including electronic medical records (EMR). The Ontario government pays approximately 70 per cent of the costs, while the FHN picks up the remaining 30 per cent.

The FHN selected Nightingale’s browser-based EMR system, which allows the doctors to share patient data on one server across all seven locations. “It’s tracked, so if I access somebody’s record inappropriately, it’s in there, it’s logged,” she said. “So it’s a reasonable balance between access and privacy – you have to have some way of auditing.” The doctors secured a contract with North York General Hospital to house the server and maintain it on their behalf.

The project got off the ground in February 2004 when funding was made available. Greiver went live with Practice Management, a billing and scheduling application, in March, and started using the myNightingale EMR system in April, which includes Clinical Encounter, Cumulative Patient Profile (CPP), Prescriptions, Lab Reports, Diagnostic Imaging and Correspondence.

But not everyone has bought into the idea. Greiver works in a two-physician office and her practice partner is not rolling out EMR. “Some physicians just won’t, and that’s been difficult,” she said. “We’re running a hybrid practice – we’re going with the same software for billing and scheduling, otherwise it would have been unmanageable. But he’s staying on paper, and that causes some friction.”

Paper shuffle
Greiver’s records are still hybrid, and it will take another six months before she doesn’t have to pull paper charts anymore. But she’s already starting to see the benefits.

Previously, doing blood work required a paper shuffle. With EMR, the lab server sends the results straight to the FHN server, so she doesn’t need to pull paper charts. The results are tracked by patient name and provincial health-care ID number, so they can’t be misfiled. “If I want to see what their previous blood work was, I just click and it shows me every blood test,” she said. “I can see it as a table or as a graph.”

MyNightingale is a browser-based application, so it can link up to hospitals and labs through an application service provider (ASP) model. “If you put in a local solution and you’re responsible for everything from the hardware to the licences, your whole infrastructure cost is huge and just to manage that you may have to employ somebody,” said Davinder Gurm, regional manager for Ontario with Nightingale Informatix Corp.

For billing applications, myNightingale links Ontario physicians to OHIP, which helps simplify the billing process. It also links up with major labs, including Gamma-Dynacare Medical Laboratories and CML (Canadian Medical Laboratories). “Traditionally clinics have been waiting for paper-based results to be mailed to them,” he said. With EMR, all lab results come in electronically, which means the patient gets his or her results back faster.

In the long term, Greiver hopes this will prevent her patients from being “orphaned” when she retires. “If you were a young physician coming out of school, why would you take over a paper-based practice?” she said.

Eventually, data will follow the patient – from emergency room to diabetes clinic, for example – instead of existing in silos. “What we’re trying to do is build something called a virtual health record that gives one patient one record from the physician’s office to the hospital to the labs,” said Gurm, “so there’s no duplication.”

But implementing EMR changes workflow to some degree, he said. “The moment you change any person’s way of doing something, there’s a pushback or slowdown – there is going to be a learning curve and they do have to understand that.”

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