Toronto clinic patients avoid  healthcare headaches with Web-based system

Imagine a world in which patients are able to check their lab test results from the comfort of their homes, submit blood pressure readings to their doctors without going to the clinic, get prescription refills online, and even decipher physician scripts.

That world may not be too far away thanks to an electronic medical records (EMR) developed by Nightingale Informatix Corp., and now being tested at a Toronto clinic.

Dubbed Nightingale On Demand, the Web-based, hosted application is helping some 100 “test” participants at the clinic avoid the usual headaches that afflict most patients – such as Long waiting lines in doctors’ offices, and worrying about lab test results.

What’s more, patients can print out instant copies of their medical history.

“The patients are very happy to have greater control over their medical records, and faster access to information that matters to them,” said Dr. David Kaplan, a physician at the North York Family Medical Centre (NYFMC), and an assistant professor of family and community medicine at the University of Toronto.

Around 6,500 to 7,000 patients visit the five-doctor clinic that Kaplan heads. Doctors see at least 70 to 90 patients a day.

With those kinds of numbers, NYFMC decided, five years ago, to streamline records management by transferring its paper-based patient records to the EMR model developed by Nightingale.

Initially, Nightingale On Demand helped doctors and clinic staff cut workload and reduce wait times for patients, but now patients are also taking advantage of the application’s self-service features.

NYFMC patients are given secure online access to their medical records through a site hosted by Nightingale. The connection enables patients to conduct a wide variety of transactions without the assistance of clinical staff or physicians – and provides them with speedier access to certain records.

For example, typically lab test results are not available to patients from two days to several weeks after the tests are done. And to obtain the results, patients either have to travel back to the lab, or schedule an appointment with their family physician.

With Nightingale On Demand, patients can to log on to the system, access their secure medical file, and view their test results and the doctor’s findings the moment they become available.

The system is also very handy for patients who need instant access to their records while in a remote location, Kaplan said.

For instance, individuals who need medical attention while vacationing in another country can get a printout of their medical records from any location where there is Internet access.

The system also helps patients to manage by themselves, conditions that typically require extensive third-party monitoring and maintenance.

Those with hypertension, for example, can monitor their blood pressure at home with inexpensive monitors purchased at a store, and send the readings to their doctors via the Internet.

At the doctor’s office, a computer screen dashboard alerts the physician to any record updates. The doctor can then bring up the patient’s file to decide what action should be taken next.

The patient can also schedule doctor’s appointments online.

NYFMC is mulling over the possibility of hooking up with local pharmacies to enable self-serve online prescription refill orders.

For now, the application helps patients avoid having to deal with the nearly unreadable physician’s script, according to Kaplan. “There’s no more need for patients or pharmacists to strain their eyes trying to decipher our penmanship. Doctors can type out very legible prescriptions, which can be read online or printed out.”

Nightingale On Demand enables authorized users to update the patient file according to strict role-based settings, and view updates provided by other authors, says Sam Chebib, CEO of Nightingale.

“Our model is based on the concept of ‘one patient, one record’, so a number of healthcare providers can populate a single patient file. This results in a single record instead of a disjointed set of records stored in separate locations.”

Rather than being locked up in an office cabinet or server, the same record is available online to all authorized users, Chebib said.

For doctors and nurses, he said, this is a definite time saver. For example, instead of searching through file cabinets, secretaries can access a patient’s electronic file with a few key strokes.

“It usually takes a doctor or attendant two to three minutes to retrieve and review a file. Nightingale can cut this down to a few seconds,” Chebib said.

But more importantly, in a wide-reaching medical emergency, a universal EMR system would be indispensable.

Imagine a drug recall. “A physician with 2,000 patients has the obligation to determine who among those patients were given that particular drug,” said Chebib.

A manual search and phone alerts to patients would take too long, while an electronic search through an EMR system could generate a report and send out e-mail alerts in minutes.

Despite these advantages, doctors across Canada are hesitant to switch their paper-based medical records systems for EMR systems such as Nightingale.

A survey by the Canadian Medical Association (CMA) indicates that only 10 per cent of Ontario doctors and 10 per cent of physicians across the country are using electronic records instead of paper charts.

The same survey indicated that cost and attitude towards change are main barriers to adoption.

Chebib said the cost to a family clinic for subscribing to a hosted EMR system starts at around $5,000 annually.

In Ontario, the Ministry of Health and Long-Term Care and the Ontario Medical Association Physician Information Technology Program is offering funding for EMR initiatives to eligible physicians.

Part of a government-backed IT enhancement initiative was launched in 2001 through the OntarioMD, subsidiary of the Ontario Medical Association the program offers subsidies of up to $28,600 to be paid over a period of three years.

Doctors who want to avail of that initiative will have to act fast because the plug is being pulled by August 31.

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