The EMR -Electronic Medical Record conundrum: The problem is not what you think it is
An EMR is an integrated health solution that is the conduit of health information. It gets the information that is needed for a health practitioner to diagnose the client and incorporate the health treatment advised. This technology has been transformational and fundamental to modern healthcare. Yet with all its advantages and needs, the EMR implementation in primary care and in the public health sector in Ontario fails to address its implementation nuances. This leads to partial satisfactory performance of the EMR and limits its true potential for community healthcare. .
There are multiple reasons primary care or public health units are driven to move to an EMR solution, everything between moving from a complete paper-based solution to EMR or an EMR transition . Regardless, the issue in implementation of this transition has a strong pattern- a consistent mismatch of what is required from the EMR transition and what it is delivering. Some common themes of problems include:
failure to adjust to the clinic,
public health unit or hospital work flows, and
staff taking extra steps in the workflow that seem to be more work arounds then optimal solutions.
Online booking issues, constant frustrations with form creations are noticeable symptoms. When implementing a single EMR across multiple hospitals showcase these issues in recent times . On a provincial level, when an integrated EMR is planned to support health tech transformation in some of its regions focusing on harmonized health information systems, have shown issues of the same nature. The recent challenges faced by Sans Quebec with its pilot launch of an integrated EMR across few of its regions is evident(CBC news so. A key piece of the puzzle is missed by even those wanting to go above and beyond.
The problem is not about transformation and its timely need in the healthcare system whether primary care or public health. The problem is there is an information deficit during the initiation phase of the project.Because leadership when deciding for a new EMR, have a notion that the solution is a one-time fix to address all the needs. This mindset inadvertently distracts the stakeholders from the work that is needed to identify which workflow-based EMR would be best to fit in their clinic, hospital or public health service. This mindset is also the result of EMR technology firms’ consistent informational pitch of their EMR solutions delivering everything the health industry needs. While their solutions are addressing the needs of public health services, when it comes to implementation, it is not a one size that can fit all. That is primarily due to lack of focus on what workflow of the hospital, clinic or public health unit aligning with the design of the EMR’s available in the market. This mismatch of what is needed and what is implemented leads to consistent pain and frustrations for the staff directly working on EMR and also having to absorb the change management that it brings into their already tough industry.
If not properly addressed, it would seem that EMR implementation would be a rare success in the Canadian healthcare ecosystem but there are solutions that can address this chronic issue. The solution is simple on paper, but it is a complex process of compiling information from different facets of workflows at different layers . For instance , before even initiating the process of selecting the EMR, the clinic, hospital or public health unit need to evaluate their current process to highlight what they need. It is a long and meticulous process which would involve those directly impacted by this EMR change. Specifically, this means the health practitioners and admin staff start from the point booking is being made to the service provided and beyond. This process will allow for discussion on what needs to be part of workflow and what might need to be removed through the transition to the new EMR or from paper-based workflows. This intuitive and consultative process would actually yield conversations around building efficiencies, form building and interoperabilities when sharing information within primary care, public health units or the ministry of health communication. This comprehensive EMR assessment would lead directly to the criteria needed to select the right EMR . Evidence-informed decision-making is crucial when making the decision for the right EMR. Sometimes the most advanced EMR with its heavy financial burden could be avoided because the clinic/hospital or public health unit's efficient workflow might not need all the advanced features at all. A clear understanding between actual needs and technology supply is pivotal in deciding the success of any EMR being implemented in a healthcare system. This informed process has led to successful EMR implementation at primary care and public healthcare units. Hence, the results are consistent with great staff satisfaction and leadership trust across the board.
Hence, it's not doom and gloom when it comes to implementing EMR across a healthcare organization whether its primary care or a public health unit, the solution involves a more clear approach of unearthing solution internally, asking the right question from the right stakeholders to make the EMR an effective part of the health service delivery system, rather than making an already run system be part of an EMR workflow which leads to nothing but paralyzing the ongoing workflows.
Author: Zarak Shah
Zarak Shah has deep operational roots within the Canadian health landscape, having led health information system initiatives at primary care and public health units ranging from health tech transformation to corporate mergers.
