MYLE EMR enables large Montréal clinic to transition to virtual care

By the middle of March of this year, the severity of the COVID-19 pandemic was clear to all, and the Goldman Herzl Family Practice Centre in Montréal was instructed to shift its regular, in-person visits to virtual encounters. In fact, management asked that 70 percent of the clinic’s volume be transferred to telemedicine visits in a matter of three days.

That was a huge challenge, as the clinic – situated at the Jewish General Hospital – has 50,000 patients and conducts some 110,000 in-person visits a year.

It also takes care of vulnerable populations, including pregnant women and their babies, patients with addiction issues, adolescents with mental health issues, and others.

It seemed like an impossible task, but the clinic did it. Within a matter of days, “we were more or less between 60 and 70 percent virtual, and by a week out we were at about 80 to 90 percent,” says Dr. Mark Karanofsky, a family physician and unit director at the Goldman Herzl Family Practice Centre.

In addition to an adept IT team, a good deal of credit must also go to the electronic medical record system used at the clinic. It’s called MYLE, produced by a Montreal-based clinical software company called MEDFAR.

The system is the most popular EMR in Quebec, with an approximate market share of 40 percent among physicians, and has some usage in Ontario and New Brunswick, but it’s not well-known outside Quebec. That may soon change as news of its capabilities and ease-of-use travels.

“Just the sheer thought of moving everything out in 72 hours makes me sick to my stomach, but it really was possible because we have these solutions,” says Dr. Karanofsky.

Indeed, MEDFAR had just added the video visit abilities, MYLE Telemed, to the system, integrating them with other features like MYLE Patient Portal and e-fax for automated transmission of test results, messages and prescriptions to the various healthcare stakeholders.

Not only was the clinic able to convert most of its appointments into virtual visits, in some cases that proved to be a real advantage.

“I can tell you that my first patient probably had bedbugs, and the fascinating thing is that we would really not want to bring him into the clinic if we could avoid it,” said Dr. Karanofsky. “That’s because we would have lost the room for the day. We would have had to have it cleaned. The fact that we were able to provide this kind of care remotely is exceptional.”

Moreover, with the power of video integrated to his EMR, Dr. Karanofsky has been able to conduct much of the work he would do at the clinic from his own home – using teleconferencing and electronic tools.

In another instance, he said, just after the COVID-19 lockdown started, “I had a patient call me who was too scared to go to the emergency room. But three days earlier he had [what seemed to be a stroke], and I could look at him and see the facial droop and the weakness in his right arm.”

“I was able to do most of what I would do in clinic, with him at his home and me at my home,” he adds.

Indeed, Dr. Karanofsky says that 70 percent to 80 percent of the patients being treated remotely can have their issue resolved over the phone or by a video visit.

“It works well and patients are able to do it on their phones, on their computers, and people are able to provide a lot of good care,” says Dr. Karanofsky.

“And really, the idea is that with COVID-19, we are trying to do the best for patients, to protect the staff and also to protect the patients from coming to a place where they might actually catch something that they didn’t have before. And so we are able to leverage all that, in one package, and I think that’s what the telemedicine solutions offers.”

‘‘Since the beginning of the pandemic, MEDFAR has focused on the success of its users to contribute to the fight against COVID-19,” comments Elias Farah, CEO of MEDFAR.

“It was clear that a virtual care system, integrated into the most popular EMR in the province, would play a major role in protecting both staff and patients. MEDFAR never hesitated to deploy MYLE Telemed free of charge to all its users during the pandemic, enabling more than 12,000 caregivers to ensure continuity of care through teleconsultation.”

Adds Farah: “It’s very gratifying to witness a successful virtual care transition at an accelerated pace like the one Herzl experienced.”

Michael Shulha, executive advisor for digital health at CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, who led the I.T. side of moving care from the clinic into the virtual realm, says that MYLE also offers other tools that have assisted both doctors and patients.

For example, the analytics component of the system, MYLE Analytics, enables the clinic to keep tabs on appointment volumes, parsing out what types of appointments are happening, where patients are coming from, how long encounters are taking and how long patients are waiting for them.

A major project for the Goldman Herzl FPC has been a diabetes improvement program, which started about two years ago. It has helped the centre standardize on best practices, and it lets doctors see where they and their patients stand in comparison to one another.

“By having these standardized comparisons, you’re able to see for yourself where you are,” said Dr. Karanofsky. “Sometimes, what you realize is, no, my patients are a little bit older, they have a lot of comorbid diseases, so maybe I shouldn’t hit the target as hard as some of my colleagues.”

The system can also provide clinical decision support. “There are ways you can put in reminders, just to nudge the behaviour in the right direction. That’s much better than using a sledgehammer, and I subscribe to that type of approach,” he says.

On another front, the MYLE system integrates an e-fax feature that allows doctors to send prescriptions directly to pharmacies. This saves time for patients and helps promote compliance, as there are fewer lost scripts, less time taken to fill the prescription, and all patients have to do is pick up their medications from the pharmacy.

“I had one patient who tested positive for strep throat,” said Dr. Karanofsky. “I sent a message to his patient portal and said your strep test is positive, please call my secretary, tell me which pharmacy you use and I will send in a prescription. I saw the message go from orange to green an hour later. He called my secretary, and I faxed the prescription while he was at work. He got his care much faster and with much less effort than would have normally been required.”

Test results are also delivered in a much more efficient way using MYLE. For example, Dr. Karanofsky is sending Pap test results to patients using secure, online notifications. “When it’s normal, I will push it to the portal, saying, your result was normal, let’s repeat this in three years – I see an orange bubble [on the patient’s record]. When they’ve opened it and they’ve seen it, it turns green, so I know they’ve received it and opened it.”

Dr. Karanofsky and Mike Shulha both agree that MYLE, with its integrated solutions – telemed, patient portal and analytics – offers a package that will serve the Herzl clinic and its patients well, now and in the future. “You need to be able to improve clinic operations from the EMR side, improve the patient experience on the portal side, and have a window into all of it with analytics,” said Shulha. MYLE delivers, they say, on all three fronts.