First EMR was installed in 2001

How did clinic arrive at its current EMR system?

By Issie Rabinovitch

Describing how clinics go from paper to electronic medical records is one of our favourite kinds of stories. We’ve chronicled many such projects in Technology for Doctors and each one has been different. There are so many choices to be made and so many options along the way that no two projects are identical.

I spoke with GP Dr. Norman Yee (pictured), of  the 8-physician Family Health Clinic, Calgary where he is also administrator of  IT systems about how his clinic achieved the high degree of computerization it now enjoys. It turns out the journey began in 2001 when FHC installed Purkinje software. It produced good results but the data was structured in a non-standard way, making it difficult to export to other applications. To make matters worse, the SQL database at the heart of the program became an unsupported product in 2005. Later that year the search for new software began.

POSP (Physician Office System Program) came out with their 2006 list and by the end of 2006 the search entered a serious phase. EMIS, the dominant EMR vendor in the UK had by then opened its first office outside the UK in Edmonton. When Technology for Doctors interviewed EMIS in November 2006, they were hosting 33 million patient records from 5,750 clinics. The numbers have grown to 40 million and 6,000 respectively. Around 56 per cent of UK primary care physicians use an EMIS EMR system each day.

EMIS according to Yee, was designed for a national system and wasn’t tuned for the kind of shared workflow found in a clinic. Nonetheless, EMIS was chosen for some of its strengths and in anticipation of future requirements in the clinic. The EMIS system was implemented in late 2007 by Enterprise Solutions Ltd., a system integrator and a partner of both EMIS and HP. OnX was engaged by EMIS, who is the single point of contact for the clinic. This simplifies matters and eliminates the possibility of buck passing.

EMIS operates on the software as a service model (SaaS). Its software runs on its servers, which also store all of the patient data. Clinics such as FHC access the EMIS servers over the internet via Access Gateway VPN technology.

Some interesting hardware choices were made in this project. Aladdin eToken PRO Smartcard was chosen to simplify and streamline to the login process. More on the benefits of this approach later. The clinic decided to locate 32 Compaq dc7900 computers throughout the clinic. There’s one mounted on the wall in each of the 12 examination rooms together with an HP 22-inch widescreen monitor on an articulated monitor arm. The remaining 20 computers are found in the reception area, hallways, and of course doctors’ and nurses’ stations.

Physicians and staff log onto the EMR servers once a day using their personalized smartcard and then, as they move about the office, take their cards with them and plug it into whatever computer they use next. There is no interruption in their work. They pick up at the exact point where they left off. Dr. Yee has done some calculations to show that the time spent logging in and out in the course of a day has been reduced by 30 minutes per doctor. That ends up saving 780 hours per year of physician time for the clinic. In other words, that gives the doctors 780 hours more to spend on patients (rather than technology).

The HP computers used to access the EMIS system have hard disks even though they function as thin clients. Thin clients were considered but rejected because the clinic intends to install voice recognition software in the near future. That works best if it is installed on the computer’s local hard drive.

Dr. Yee’s answer to my next question, “Why HP desktop computers?” was interesting. In his experience most support incidents in a clinic environment are hardware oriented. Dell computers were considered but, Yee told me, Dell sources components from a variety of suppliers, primarily to reduce costs. This leads to inconsistency, even among units of the same model, and that leads to support problems. Although HP computers are somewhat more expensive, Dr. Yee has found that they are more dependable and that HP is more corporate in orientation than Dell.

The way the computers are setup in the examination rooms allows the doctor to always face the patient. The screens pivot as desired. Templates reduce the chore of inputting data and, according to Dr. Yee, between half and two-thirds of patient visits are fully documented during the visit. Later, the EMR system extracts coded data about the patient encounter and passes it along to the practice’s billing software.
The use of EMR has benefited the clinic in many ways, some subtle and others fairly obvious. For example, the clinic grew from 4 to 8 doctors without needing to add another staff person. There is less paper to file and Dr. Yee feels that the saving on filing alone amounts to at least $50,000 per year in salary. On the more subtle side, Dr. Yee provided many examples of how using a sophisticated electronic patient record management system enables his clinic to provide better care to patients.

I had more questions than time permitted but as we wrapped up our conversation, Dr. Yee left me with a good quote: “Doctors are knowledge workers. They’re information managers who can’t do their jobs properly without the right IT tools.”

Posted March 4, 2010