Clinic's size convinces FP's to go electronic

by Catherine Teasdale

OSHAWA, Ont. - The Glazier Medical Centre, with 18 family physicians and 12 specialists, is probably the largest clinic in Ontario to have gone completely electronic.

The group installed their electronic medical record (EMR) network in January. Typically, large clinics take longer to come to a consensus on whether to computerize but with this group, it was the clinic's size that convinced them that they had to go the EMR route.

The clinic is large - in fact, the space at one time was zoned to be a hotel. Yet, one of the biggest problems of housing so many doctors under one roof is finding the room for all those patient charts.

"We have a central chart room with almost 100,000 charts, not to mention another room of similar space full of dead files," said Dr. Christopher Hall, a family physician in the clinic. EMR, he said, would help them compress their storage space.

In the past, one of their space-saving measures was to keep a single patient's information in one "all-uniform chart," rather than each doctor keeping charts on their own patient population. Although this helped keep storage space down, it was also a logistical nightmare for the staff to keep track of all those records.

"It was a really labour-intensive process, never mind the process of getting the lab results and hospital reports back in[to the chart]. That's one of the reasons that we said, 'This is crazy. We've got too much invested in time and too many good staff who should be doing something more useful for patient care.'"

The all-uniform chart, in fact, made it easier for the group to go electronic but computerization wasn't hassle-free. The phones got backed up, patients got a little frustrated, and on one occasion the system would crash.

"In the beginning the system came crashing down a few times. It was very worrisome to have no computer systems anywhere. No scheduling, nothing for 10-15 minutes."

Glitches are expected in the beginning, he said, especially given that at any time during the day the system could have 80 users (physicians and staff) on-line at the same time.

Although Dr. Hall hasn't seen any vast time efficiencies after two weeks with the new system, he said that he is no longer losing any time either. "I can do my day's work, put my information on [the computer], do my letters and be done at the same time at the end of the day that it would have been done otherwise."

Cost-benefit analysis

The physicians at the Glazier Medical Centre didn't take a blind leap of faith when choosing their computer system. In fact, the group looked at half a dozen programs and saw several demos before selecting a provier. It wasn't a "let's-do-it decision overnight. It took about six months," said Dr. Hall.

The process they went through to find the right company was extensive, he said. In fact, in previous years, they had discussed fully computerizing the building but had found it wasn't the right time because computerization was still "too expensive, the voice dictation wasn't quite there yet and the systems weren't quite good enough."

Fully computerizing the office was inevitable, the only question that remained was when to do it. Instead of waiting to be told to computerize and what provider to use, the doctors wanted to choose a system on their own terms.

So, about a year ago, they struck a sub-committee and sent out tenders. Based on written responses from a half dozen companies, the group saw five prospective providers. Eventually they chose the Jonoke System based out of Edmonton, Alta.

Benefits

Each staff member had two days of training; the physicians were trained in two evenings and one day on a weekend. The training, however, didn't stop when class was out.

The group has a computer set up in the lunch room so that when they break to have a bete to eat they can also take in an impromptu computer session. The benefit of such a large group computerizing together is that "we learn from each other," said Dr. Hall.

"I am anything other than computer crazy," he said, but the system is fairly simple. Being a quick keyboarder isn't essential either, he explained, because much of the record keeping can be done using templates - one can just call up a condition and add and delete from the template to make it unique for the patient.

Electronic medical records can't help but improve a practice because it forces a physician to be current, legible and complete, he said. "We all look after each other' patients on an urgent care basis. I have enough notes that I cannot read - which have not helped the patient or me - and now it's legible."

When seeing a colleague's patient, he can now access the patient's background history, allergies, current medications and send his partner an electronic note about what treatment was given.

The computer prompts the user all the time. For instance, he said, "If you go to order a drug, it puts in front of you the side effects and interactions of that drug."

It also allows the group to look at their own patterns of practice. Patients on drugs that are recalled or drugs that have gone off the market can be easily tracked down on this system and notified.

Financing

"Tendency for physicians is to only look at the up front costs. The thing is to shift the focus,"said Jody Beven, president of Jonoke Software Development Inc. "The first 8-12 months the costs are going to be higher."

The group at the Glazier Medical Centre financed their system by taking out a five-year bank loan. "My hope is that we will not be behind the game. There is an initial heavy outlay. But spreading it out over five years, well, it's money we would have spent anyway," said Dr. Hall. He expects that it will take two more patients a day to cover the cost of the equipment.

"If at the end of the day we have done nothing but improve our patient care and not absurdly increased our expenses then great, everyone wins."

And this greater efficiency doesn't mean doctors will have to hand out pink slips to staff members. "We have not seen a single clinic lay people off," said Bevan. "What they have done is taken on more doctors or more work without having to increase staff."

Dr. Hall hopes that the system will help the centre attract new physician. "Now that some of the partners are reaching retirement, we would like to add two or three physicians to the group. But it's a tough market to find physicians who would like to come to your community. We think this is one more edge that we will have which might attract keen capable people who would like to have the benefits of EMR."

From Family Practice, The Maclean Hunter Newspaper for Family Physicians
April 7, 1999, Vol. 11, No. 7, p. 28