Dr. Sol Werb scoffs at the notion that storing medical records off-site is somehow less secure than storing paper files in an office.His office has been broken into three times by burglars who were evidently looking for drugs to use or to sell. In one case, they got away with allergy medication, though he’s not entirely sure how that was useful to them.
“Look at my office,” he said to a Communications & Networking reporter during an interview in his waiting room. “How secure is it?”
With the files stored off-site at Nightingale’s data centre, thieves could steal his Toshiba tablet or one of the two office PCs but they would not get any patient information, he said. All they would find is an Internet bookmark for Nightingale’s logon screen, and they would need two levels of passwords and an RSA security to access anyone’s file.
20 hours a week on paperwork
All Internet transmissions are protected using Secure Sockets Layer (SSL) and customers have the option of purchasing virtual private networking (VPN), said Peter Tyson, Nightingale’s vice-president for development and IT.
Nightingale’s medical software is designed to comply with standard government IS security requirements, Tyson said, adding they can block access from certain machines or restrict access to certain users or groups of users.
But information security was not the main reason Dr. Werb chose Nightingale EMR. The 57-year-old practitioner was ready to retire from medicine because he was spending too much time writing notes by hand to comply with the requirements of both the Ontario Health Insurance Plan (OHIP) and the College of Physicians and Surgeons of Ontario.
Before he bought the system, he was spending nearly 30 hours a week maintaining patient files, often working until 10:00 p.m. and taking files home with him.
EMR saves time because it has reusable forms, he said. For example, when interviewing a patient during an annual physical exam, he can record answers by filling in yes or no answers on an electronic form. When he needs to make detailed notes, he can then enter information into a field using either a keypad or the handwriting recognition feature of the tablet PC.
He has set up his own templates for conditions for which numerous patients visit the doctor, including the common cold. Before he bought Nightingale EMR, it would typically take Dr. Werb four minutes to complete his notes on a patient with common cold symptoms. Now it usually takes him 30 seconds using the EMR template he created for the common cold, which includes a field for the advice he would give to a typical patient. If one patient does not fit the typical pattern, he can use his stylus to make the necessary changes to that patient’s chart. Although one patient may save him 3-1/2 minutes, Werb said it adds up to a significant amount of time when he sees 25 patients with common cold symptoms in a typical day.
Negatives must be recorded
Once Dr. Werb has completed a patient chart, he can print it and save the files to the patient’s electronic medical record. Not only does this update the patient’s medical record, but it also comes in handy if inspectors from OHIP or the College of Physicians and Surgeons pay a visit, Dr. Werb said.
OHIP and the College will do spot-checks of patient records to confirm there are records to show the procedures billed to the provincial health program were done thoroughly, he said, adding doctors are required to note relevant negatives — signs or symptoms the patients do not have. For example, if a patient undergoing a complete physical reports no foot problems, the doctor must note there are no foot problems, Dr. Werb said.
Nightingale sells EMR using the application service provider (ASP) model, where a customer pays a setup fee and a monthly service fee. A typical customer would pay about $450 per month.