Technology adoption

How I learned to stop worrying and love my EMR

By Rosie Lombardi

Many older doctors are leery of technology, and are sometimes blamed for holding up the implementation of EMRs. But perhaps they have good reason to be wary of rigid, inflexible EMR systems that force them to change the way they interact with patients. One doctor’s experience with an American EMR system, which he hated, and a Canadian one, which he loves, illustrates some of the system design issues medical practices need to consider when making a selection.

Dr. Ronald Eliosoff (pictured) is a 65-year-old physician who practices family and internal medicine at the Appletree Medical Group, an Ottawa-based chain of walk-in clinics. “I’m very low tech. I have trouble making my cell phone and TV work,” he says.

Eliosoff moved to Canada from the U.S. four years ago, driven away in part by the EMR system that was implemented at his previous medical clinic. “I had a major problem with it and it was part of the reason that I left the U.S. I had to enter all my clinic notes into point-and-click templates. It didn’t allow me tell a narrative story, using the patient’s words, which to me is critical.”

Eliosoff says that this template approach is fine for collating data but unsuitable for medical practice. “Almost 90 percent of the information you need comes from the patient’s history. But the design of the program was likely mandated by American insurance companies.”

When he moved to Canada, he thought he was going into a non-EMR environment at Appletree. “Had they told me there was an EMR in place during the phone interview, I would have cancelled my in-person interview later. That’s how strongly I felt about it at the time.”

But his experience with Appletree’s EMR has changed his views. “I’m a convert now. I find the EMR extremely helpful to the point that I would find it very difficult to practice medicine without it.”

A major advantage in Appletree’s EMR system is that it allows for a variety of documentation and charting methods: handwriting, dictation, voice-to-text and typing, says Eliosoff. Each method has a concomitant data capture component, for example, handwritten notes are converted to an image file that’s stored in the patient’s record.

“That template input method in the American EMR was a show stopper for me. But even a template approach might be alright if it offers other options for people who don’t want to use the system that way.”

Eliosoff says he prefers dictating his notes, which he edits for errors after they’re transcribed by support staff. Appletree offers a flow-through transcription service with a 48 hour turnaround with its EMR.

Called EMR Advantage, the system was developed by physicians at Canadian Health Systems Inc., which is affiliated with the Appletree Medical Group. The EMR is offered as part of the soup-to-nuts turnkey, franchise and business solutions offered to medical practices by Appletree, but it can also be purchased separately, according to its president, Dr. Thom Tyson.

“The way the system is laid out, it follows the logical processes and steps a doctor would go through to collect information and make decisions about the patient. It’s very clear to me it was designed by doctors,” says Eliosoff.

He says he learned how to use the system slowly, but was able to use the basic functions he needed to operate initially fairly quickly. “I did my notes the way I like, which was a relief, then learned how to write prescriptions and order basic tests – those were very simple and I learned them quickly. I don’t do the many things I could do, but for a low-tech guy, the basic features of the system are very easy.”

The system offers other features that he uses. Patient records can be easily retrieved from any clinic within the Appletree chain, which comprises about 10 percent of Ottawa’s medical clinics. Billings can be checked daily, monthly and yearly. Diagnostic tests can be ordered directly from the EMR, and results can be checked quickly.

There are features offered in most EMRs, but there are also other features that Eliosoff says are very handy. For example, messages from people trying to contact him are displayed right away when he opens the system. Referring patients to other specialists is easy. “The EMR lists all the ENTs in the Ottawa area, for example, and I can just push a button for the one I want, I can note why by pushing another button, and I can see relevant lab results by pushing another.”

He says Appletree continues to evolve the system based on feedback from its users. “I give personalized instructions to patients who are flying and need to avoid ear problems, have diabetes and so on. I used to write them out, but they upgraded to a system where I can create a template, personalize it and push a button to print it.”

Using an EMR has increased his productivity. “People have the perception that I spend much more time with them than they’re used to. It speeds me up so I can see more patients, and they don’t feel rushed. All the time I spend I’m focused on them and not leafing through folders or writing prescriptions.”

His message to older doctors is that it’s easier than you think if the right system is used. “Four years ago, I was opposed to EMRs because the versions I saw were focused on templates and I couldn’t get past that. But there are some systems that are really easy to use even by someone who’s not computer literate. I have no idea how the EMR works, but I drive a car reasonably well, and I have no idea where the spark plugs are.”

Posted July 8, 2010