Since the start of the new year I have heard about significant management changes at a number of Canadian EMR vendors. The most recent such change is the departure of Healthscreen’s CEO, Justin Belobaba. According to a media release dated March 4th, 2011, Mr. Belobaba has been replaced by Mr. Stewart Davis, Healthscreen’s Chief Operating Officer.
Although few details regarding the reasons for these management changes are publicly available, there are rumours that financial pressures and poor sales results are a contributing factors. As the industry exhausts the early adopter and early mainstream physicians, are they encountering increased difficulties selling their solutions to the more skeptical and demanding late mainstream and laggard physicians? Were provincial government forecasts for physician adoption of EMRs overly optimistic?
According to an article posted on the CTV Toronto website, Health Minister Deb Matthews is quoted as saying:
“We’ve got more physicians with electronic medical records than any other province in the country. We are now a leader when it comes to the adoption of it.”
Hang on just a sec, Minister Matthews. I am huge proponent of the value of EMRs in physician offices and I think that there is a critical role for eHealth Ontario to play in driving use of IT in healthcare. HOWEVER … I think that it is disingenuous to say that Ontario is a leader just because nearly 5,500 doctors have installed an EMR.
To start, according to Canadian Medical Association statistics, only three provinces (QC, QB, and BC) have more than 5,500 doctors and only one province (QC) has more than 5,500 family physicians (the type of physician typically targeted for an EMR). So, the claim that Ontario has more doctors that have adopted an EMR than any other province is a rather hallow victory. What would be more useful is a comparison expressed in terms of a percentage of the doctors in each province. I highly suspect when viewed in this light that Ontario is not the leading province in terms of EMR adoption.
Another important distinction is “adoption” vs “use”. Just because a physician has installed an EMR doesn’t mean that they are making “meaningful use”. A 2009 Commonwealth Fund study showed that both Canada and the US lagged most other industrialized countries in using many of the EMR functions that offer significant clinical benefits. It would be interesting to know the extent to which the 5,500 doctors who have an installed an EMR are making “meaningful use” of this technology.
As I said earlier in this blog post, I think that Ontario is on the right track with its program to drive EMR adoption and use. Further, I believe that OntarioMD, the group set up within the Ontario Medical Association to implement Ontario’s EMR program, is making good progress and has many good initiatives in place. I just don’t believe that we should ignore or gloss over the facts in pursuit of a good news story.
At the end of August I published a blog post entitled “Meaningful Engagement” in which I explored lessons that might be learned from the US process for defining “meaningful use”. In that blog post I reference an article entitled “Certification of Primary Care Electronic Health Records: Lessons Learned from Canada” written by Dr. Mark Dermer and Dr. Matthew Morgan. Although the article offers insights on the engagement process that led to the definition of meaningful use, its primary purpose is to explore the Canadian EMR certification process. In their assessment of Canadian EMR programs, Drs. Dermer and Morgan assert that “the significant variation in which products are chosen in competitions that use very similar specifications (derived from Infoway’s POSR) calls into question the process by which products are evaluated“. To further illustrate the points made in the article, I analyzed data that I have collected on the Canadian EMR market and offer the following observations for consideration:
- According to Dr. Alan Brookstone from CanadianEMR, there are approximately 35 vendors offering some form of EMR solution to Canadian physicians.
- Nearly all of the 35 EMR vendors are Canadian companies.
- Sixteen or slightly less than half of these vendors have products that have been certified by one or more of the six provincial EMR programs (BC, AB, SK, MB, ON, and NS).
- None of the sixteen certified vendors has products which are certified by all six provincial EMR programs.
- Only one vendor has product which has been certified by four of the six provincial programs.
- The majority (62%) of the 16 vendors whose products have been certified by a provincial program have only been certified by a single program.
Posted in Uncategorized
Tagged Canada Health Infoway, CanadianEMR, Certification of Primary Care Electronic Health Records, Dr. Mark Dermer, Dr. Matthew Morgan, EMR, Infoway, OntarioMD, PHIM, PITO, POSP
I have written several articles in Healthcare Information Management & Communications Canada (on my own and co-authored with Bill Pascal, CTO for the Canadian Medical Association) regarding the need for a more “bottom approach” to integrating health IT systems across the continuum of care. The crux of my argument is that the health sector is more an “ecosystem” and less an “enterprise”. Hence, top down approaches are less likely to deliver tangible results in reasonable periods of time and are have a higher probability of failure.
Given my perspective on the need for more bottom initiatives, I was very interested to hear about a local integration project led by OntarioMD with funding from eHealth Ontario. Physicians at the Barrie and Community Family Health Team are now electronically receiving patient reports from the Royal Victoria Hospital in Barrie. These reports are transferred directly into the family health team’s EMR and include:
- Medical reports including discharge, consult, oncology, and surgery
- Diagnostic imaging reports (text only)
A key feature of the newly developed electronic Hospital Report Manager is that works with any EMR subsidized by Ontario’s EMR Adoption Program and can be used by any Ontario hospital. EMR vendors need only develop a single interface to the Hospital Report Manager while each Hospital need only develop a single interface to the Hospital Report Manager.
Vendors involved in developing the Hospital Report Manager include:
- Orion Health whose Rhapsody integration engine is at the heart of the Hospital Report Manager
- Clinicare whose EMR product is used by the Barrie and Community Family Health Team.
- MyDDS and Graphically Speaking who developed the underlying database for routing reports
- Praxia which is conducting project evaluations
- Trusted by Design which performed the Privacy Impact Assessment
- Healthvision who developed the interface to the hospital’s Meditech hospital information system
Phase 2 is currently underway which will extend the scope of the project to additional participants including four new family health teams and three new hospitals. Phase 3 and beyond depends upon availability of additional funding from eHealth Ontario.
As both Canada and the US move to aggressively to promote use and adoption of IT by family physicians in their offices, the most recent survey results from KLAS offers some cause for concern:
KLAS surveys end users to determine what they like and don’t like about IT systems that they have purchased. These surveys offer unique insights as they are based on actual use of healthcare IT systems in real world settings. According to Modern Healthcare article, the latest KLAS survey “shows a deterioration of customer-satisfaction scores across the board compared with the survey from the prior year“. Of potential concern to government sponsored funding programs are the results for ambulatory EHRs (referred to as EMRs in Canada). This category had the lowest average satisfaction score of the 24 software categories covered by the KLAS survey.
KLAS President, Adam Gale, offers several explanations:
- “That could mean that vendors are selling more and unable to fully staff the uptake.”
- “The more enthusiastic and tolerant earlier adopters have already acquired and are already using EHRs. Users new to the technology are adopting now.”
Both explanations are distressing, though the suggestion that mainstream physicians may not be happy with existing EMR products could seriously impact the aggressive targets for EMR use and adoption set by various EMR funding programs.
Is EMR software ready for those physicians who are not early adopters of technology? As Dr. Alan Brookstone notes on his blog:
there are other signs in the US that physicians do not feel that EMR software offers sufficient value to warrant the necessary investments. I think that we must heed these early warning signs and take a closer look at how best to integrate IT into the clinical practice of family physicians so that our current round of funding is not seen as “wasted” in a future auditors report.
Well, finally some good news for eHealth in Ontario:
Although long anticipated, new funding for physician office EMRs is an important component of the Ontario eHealth strategy. With all the talk about budget cuts and the delays to Infoway funding, I am very pleased to see the Ontario government commit to getting family physicians on-line. Given that nearly 80% of all healthcare interactions take place with a family physician, getting the health records associated with these visits in electronic form is a critically important step.