Canadian EMR Adoption and Use – Additional Analysis

After writing yesterday’s post summarizing key data from the 2010 National Physicians Survey (NPS), I spent a few minutes catching up on blog posts on other blogs.  I came across a post from my fellow Canadian blogger and friend, Dr. Alan Brookstone, on his CanadianEMR blog in which he also commented on the NPS survey data.   Not only does Dr. Brookstone closely track EMR activity, as a physician and early EMR adopter he is intimately familiar with the EMR market and is well qualified to comment on this market.   Check out Dr. Brookstone’s blog post for an insightful analysis of the NPS data.

Mike

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Observations on the Canadian EMR Market

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.

Mike

My eHealth 2010 Presentation

On Monday, May 30th, Dr. Alan Brookstone and I delivered a presentation entitled “Physician Use of IT: Lessons Learned” at the annual COACH eHealth conference.  You can find a copy of the presentation here.

Mike

Dr. Alan Brookstone – Avoid the Boondoogle

Dr. Alan Brookstone is a Canadian pioneer in the use and adoption of electronic medical records in physician offices.  Having automated his own office, Dr. Brookstone embarked on a crusade to help other doctors do the same.  He created a blog to share the lessons that he learned implementing an electronic medical record in his office.  This blog evolved to become CanadianEMR, a web site with a rich suite of features to help physicians choose and make best use an electronic medical record.  Most recently, Dr. Brookstone launched AmericanEHR in partnership with the American College of Physicians to expand his presence into the U.S.

In addition to automating his own practice and sharing his insights with other physicians, Dr. Brookstone has consulted with various healthcare organizations across Canada and abroad on the use of information technology to transform the delivery of healthcare services.  One of these organizations is Canada Health Infoway.

Having tried to work from the inside to effect change at Canada Health Infoway, Dr. Brookstone has published a public comment on what he feels are changes that must be made to “avoid the boondoogle” of interoperable electronic health records. You can read Dr. Brookstone’s comments at:

http://network.nationalpost.com/NP/blogs/fullcomment/archive/2010/04/12/avoid-the-boondoggle.aspx

Mike

iPad in Healthcare

I continue to be amazed at the attention that the iPad is receiving, both in the mainstream press and in the blogosphere.  As the three main focus areas of my consulting practice are eHealth, mobility, and social media, I am tracking iPad discussions quite closely.  In the health sector there is active debate as to whether the iPad will a suitable platform for physician practices.  Dr. Alan Brookstone explores this topic today in his CanadianEMR blog (http://blog.canadianemr.ca/).  He notes that a recent survey by health IT software vendor ePocrates found that 59% of physicians are considering purchase of iPad, with 21% indicated that they will buy one sometime this year.

In related iPad news, two FCC officials have voiced their concerns about the impact of the iPad on mobile network congestion.

http://www.fiercebroadbandwireless.com/story/fcc-argues-more-spectrum-apples-ipad-makes-appearance/2010-02-07?utm_medium=nl&utm_source=internal

The story notes that these officials are concerned that potential network capacity problems “are reminiscent of congestion problems AOL experienced in the 1990s when it decided to allow unlimited Internet use.” The two officials are quoted as saying that “”..wireless network congestion today reveals intense demand for wireless broadband. Widespread use of smartphones, 3G-enabled netbooks, and now, perhaps, the iPad and its competitors demonstrate that wireless broadband will be a hugely important part of the broadband ecosystem as we move ahead.”

I think believe that we will see a renewed and intense interest in “tablet” computing with the debut of the iPad and other similar devices from vendors such as HP (which announced their “slate” computer at CES earlier this year).  I think that Apple’s decision to use the iPhone OS instead of MacOS will encourage active development of iPad applications, a key driver for tablet use.  The immediate availability of 140,000+ iPhone applications plus near daily announcements by software vendors of plans to release new applications designed specifically for the iPad bode well for widespread iPad adoption.

Mike

Are mainstream physicians a tougher audience?

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:

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20091215/REG/312159955/1029

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:

http://blog.canadianemr.ca/canadianemr/2009/12/is-the-us-it-program-heading-in-the-right-direction.html

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.

Mike