Dr. Graham Jacques
is one of eleven physicians who work at the St. Lawrence Medical
Clinic, a rural clinic based in Morrisburg that encompasses four
locations along the St. Lawrence Seaway south of Ottawa. The
St. Lawrence clinic has recently switched to an Electronic Medical
Record system. Dr Jacques was kind enough to share the clinic's
experience.
Motivating factors behind the transition included the need for
real-time communication amongst the multiple office locations
and access to patient records from any
office location and the hospital. In addition, the prospect of significant timesavings,
perhaps resulting in a reduced workload, was appealing.
After reviewing several EMR systems, a decision was made in favour of Jonoke's,
in part since the clinic was already using Jonoke's booking and billing software
and was pleased with itThe clinic has been using their new EMR system for about
two months, and although Dr. Jacques suspects it may be several more months before
all of their paper records are converted, short-term benefits are already apparent.
Accessing the System
The ability to connect to the EMR system relies on access to the Internet since
the EMR server (the computer responsible for storing & sorting the data)
is housed in the clinic's main office. Using the Internet enables the physicians
to communicate with the server from any of the four offices, from home, and Dr.
Jacques was even able to work from a hotel with Internet access. Hospital access
to the Internet is forthcoming in the near future. Updating and referencing charts
is no longer limited to having the patient's file in hand which affords the physicians
greater flexibility in finishing paperwork.
Although desktop computers are available in the office, utilization of the clinic's
EMR is extended by the use of laptop and tablet computers. Each physician has
their own portable computer that can connect to the Internet and network, either
in the office or remotely, using Wi-Fi (a wireless technology) or Ethernet cables
(the customary “wired” connection to the Internet). The speed of
connection using wireless technology can be a bit slower, so the St. Lawrence
Clinic uses software called “Missilesoft” to facilitate remote connections.
Conversion Process
Converting the clinic's almost 15,000 patient records to electronic format will
take some time. However, the installation of the hardware system took just under
two weeks and training on the new system was spread out over a week. After the
training period was completed, it was possible to immediately use the system
to create or update records.
Benefits
It may be a year before all the benefits of switching from paper to electronic
records are realized. Despite this, Dr Jacques expects favourable results and
some of the benefits of the transition have either already made an impact or
will do so in the near future. These benefits are:
* Flexibility – work can be accomplished in several locations
* Efficiency – the need for duplication is reduced, no need to access patient's
physical chart to write referrals or prescriptions, get work done faster
* Legibility – increased legibility of documents There are other advantages
the clinic expects to see in the long term, and these include incorporating scanned
documents into the records, populating records with lab data, filling out forms
electronically and reducing the offices' dependency on paper.
Challenges
All of the clinic's physicians were familiar with the use of computers for word
processing and web browsing, but ease of use of the EMR was a major challenge.
Even with a simple interface, there is a learning curve involved in transferring
to a new system; training and time are required to become comfortable with an
EMR. The St. Lawrence clinic may have mitigated some of the time spent on training
by using an EMR provided by the same company that supplies their booking and
billing software.
Cost was another consideration; in addition to purchasing EMR software and its
requisite hardware the clinic replaced all of their computers. Based on the clinic's
previous configuration of Pentium II computers with 2-5 GB hard drives and 200-400
MHz processing speeds, it was determined that the usability of the software would
be enhanced by utilizing an up-to-date network which would require new computers.
Setting up the network was left to Jonoke, who also provided two onsite technicians
for a couple of weeks to ensure a smoother transition. Additional advice was
provided by an independent technical consultant ensuring the St. Lawrence Medical
Clinic obtained a system that met their requirements.
In Practice
Most of the physicians at the clinic have shown great commitment to using the
new technology, although the degree to which individual physicians incorporate
it into their routine during the conversion varies.
Real-time communication, greater security and reduced geographic limitations
should provide Dr. Jacques and the rest of the St. Lawrence Medical Clinic with
a more flexible and efficient work environment.
- St. Lawrence MediFile Clinic featured at http://www.oma.org/cybermed/tech/featured_spotlight.htm
(August 2005)