Tom Bowden from HealthLINK Podcast

Tom Bowden, Chief Executive of HealthLINK talks to CanadianEMR about New Zealand’s EMR adoption in primary care.

Listen to the podcast here.

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Medicine 2.0

The Medicine 2.0 Congress was held last week in Toronto, Canada. I attended on my way back from the AMEE 2008 conference in Prague.

My role was to chair the session on medical education on day 1 and to present 2 talks on day 2, one on mobile computing and one on online communities.

The event was a great opportunity to catch up with my health informatics colleagues and meet face-to-face with previously only online acquaintances.

Peter Murray gave an excellent keynote address, introducing the conference and some of the themes of Medicine 2.0 on behalf of the IMIA. Gunther Eysenbach followed with his welcome and an introduction to the concept of ‘Apomediation’. For those not in the know, you can read up on apomediation in his JMIR article introducing the concept.

The ‘Medical Bloggers’ panel consisted of Berci Mesko, Peter Murray, Jen McCabe Gorman, Keith Kaplan and Sam Solomon. The panel included some great presentations, and I found Sam’s tale of medical blogging gone wrong particularly interesting.

After lunch, I listened to Leanne Bowler talk about teen health sites and Margaret Hansen gave us an insight into the world of virtual reality medical education.

Next up was the session I chaired on Medical Education. We had a great presentation from Panos Bamidis, who talked about the use of Moodle and other e-learning technologies he uses on his Medical Informatics courses. Deidre Bonnycastle was a very enthusiastic advocate of e-learning tools and told us about the various technologies she had tried at the University of Saskatchewan. Berci Mesko gave a very interesting talk about protecting your online reputation and he also showed us some of the fascinating presentations he has attended in Second Life. Finally, Rod Ward livened up the crowd with an animated discussion about all aspects of the use of Web 2.0 technology in medical education.

The next day kicked off with talks from Judy Proudfoot, Caryl Barnes and Lisa Whitehead on the subject of Methodological Issues and Challenges in eHealth Research.

Next up was my session with Carol Bond, Shirley Fenton, myself and Ken Seto. We talked about various aspects of running online medical communities for education and developing professional connections.

After lunch I gave another presentation, this time on the role of mobile technology in medicine. My co-presenters for the session included Benjamin Hughes and Indra Joshi, who talked about the kinds of websites junior doctors used; Miguel Cabrer, who demonstrated the amazing MedTing platform; and Marcelino Cabrera Giraldez, who talked about how Web 2.0 can be used for patients with rare diseases.

The day rounded off with presentations from Joan Dzenowagis of the WHO and Kevin Clauson who gave a very entertaining and interactive session on the risks associated with Web 2.0.

For more coverage of the conference check out:

Peter Murray on the HI Krew:

Rod Ward on Informaticopia:

Berci Mesko on Scienceroll:

John Sharp on eHealth:

Neil Versel on the Healthcare IT Blog:

Kate Jongbloed on Unpacking Development:

Even more at:

OpenMRS on the BBC

The BBC website is running an article on OpenMRS, the open source medical records package:

A free and simple piece of software is helping manage the spread of disease in developing countries.

The Open Medical Record System (OpenMRS) is providing countries, such as South Africa, with an online patient medical record system.

It does not require any programming knowledge and is helping to improve how people are cared for and treated.

It could transform the prevention and treatment of diseases such as HIV and Aids, its developers say.

Many projects designed to tackle the disease manage their information with simple spreadsheets, poorly designed databases and sometimes nothing at all.

But with 40 million people infected or dying from the disease globally, the majority in developing countries, an effective medical record system has been badly needed.

It’s about storing and representing information, then building things like decision support
Paul Biondich

“Our mission is to build a health records system in support of direct patient care, on the ground for the very poorest of the poor,” Dr Paul Biondich, a paediatrician at the Regenstrief Institute in the US and one of the co-founders of OpenMRS told the BBC World Service’s Digital Planet.OpenMRS was formed in 2004 and is a free application that has already been rolled out in many African countries, including, Kenya, South Africa and Rwanda.

The system has been designed so that information can be stored in a way that makes it easy to summarise and analyse patient information.

“In taking care of patients there is a process of both being able to gather and interpret information to make informed decisions about what should be done with an individual.

“That need to manage information is what electronic medical record systems is all about”, he said.

Sorting information

At its core, OpenMRS has a so-called “concept dictionary” that stores all diagnoses, tests, procedures, drugs and other general information.

“In some cases – especially in the context of HIV in Africa – we are seeing that an increasing amount of care is being provided by practitioners that have had less direct experience”, said Dr Biondich.

The intention is to create a system that allows clinicians to gather information about their HIV patients
Paul Biondich

Using a system like OpenMRS, can help to present the information in ways that help make better-informed medical decisions.”The intention is to create a system that allows clinicians to gather information about their HIV patients.

“For example, their physical exam findings and their laboratory test results, like the CD4 count (a measure of the strength of the immune system) and the types of medications that they have been placed on.

“By capturing that information the idea is that on subsequent visits that information can be used to further drive the process of care.

The system also has a feature called “decision support”, which provides tips to clinicians about prescriptions and tests which may be necessary.

Developing systems

A conference in Durban, South Africa, has just taken place for users of the system and developers from the open source community.

“What we are trying to do is get some ground swell of interest around this technology,” said Dr Biondich. “What we are finding is that there are a lot of geeks within Africa that have taught us a lot about good system design.

“We are working together with them to build these systems, such that they become their own over time.

“We can come and bring ideas and share but the whole point of this is to create a learning community, where ultimately communities become responsible for the development and further growth of these systems”, he said.

Link

NYT on Doctors and EMRs

The New York Times has an article about the recent NEJM report on the low uptake of EMR software by US doctors:

Dr. Paul Feldan, one of three doctors in a primary care practice in Mount Laurel, N.J., considered investing in electronic health records, and decided against it. The initial cost of upgrading the office’s personal computers, buying new software and obtaining technical support to make the shift would be $15,000 to $20,000 a doctor, he estimated. Then, during the time-consuming conversion from paper to computer records, the practice would be able to see far fewer patients, perhaps doubling the cost.

“Certainly, the idea of electronic records is terrific,” Dr. Feldan said. “But if we don’t see patients, we don’t get paid. The economics of it just seem so daunting.”

Private and government insurers and hospitals can save money as a result of less paper handling, lower administration expenses and fewer unnecessary lab tests when they are connected to electronic health records in doctors’ offices. Still, it is mainly doctors who bear the burden making the initial investment.

“We have a broken market for electronic health record adoption because the people who gain financially are not the people who pay,” said Dr. Blackford Middleton, a health technology expert at Partners Healthcare, a nonprofit medical group that includes Massachusetts General Hospital in Boston.

To fix the market, Dr. Middleton, like others, recommends that the government play a role in providing incentives or subsidies to speed the use of computerized patient records in the United States, whose adoption rate trails most developed nations.

http://www.nytimes.com/2008/06/19/technology/19patient.html?ei=5087&em=&en=a96bd12a6eac39e3&ex=1214193600&adxnnl=1&adxnnlx=1214035886-aTTu+8k374ncfMANn9iAXw

Electronic Medical Records: US Doctors 4%, NZ Doctors 60%

A recent NEJM study of US family doctors shows that just 4% are using Electronic Medical Records (EMR) systems fully (13% using a basic system). This compares to 60% of family doctors in New Zealand. (Update: The Commonwealth Fund survey gives a figure of 92% of NZ family doctors using EMR systems – it also gives a figure of 28% of US doctors).

Abstract

Background Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians’ adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption. Methods In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices.

Results Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records.

Conclusions Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems.