Case Studies
Embracing Change Brings Positive Outcomes, Says Summerland GP
Dr Khati Hendry is a GP in a group practice in Summerland, and has been a practising physician since 1980. She was halfway through college when she decided on medicine as a career. “I was thinking about how to be useful in the world,” she said. “In the US, it was the beginning of the community health movement, and coming from a grass-roots perspective it was important to me to be a direct change agent in the world.”
Dr Hendry moved to Canada in 2004 in search of a better life and personal opportunities. “I worked for a long time in the US to improve the health care system, and I thought it would really be nice to experience working in a more equitable health care environment,” she explained.
Advice to Colleagues
“One-time training from the vendor is not enough. People are at different levels of need at different times. You need ongoing information at the time you’re ready and able to accept it.”
“Communities of practice and the Peer-to-Peer Program are designed so that when you need help, people who’ve actually been there and gone through it can offer help and advice. There’s no substitute for that.”
Community of Practice – Benefits of Collaboration
Rosedale Medical Associates is a six-physician practice in the South Okanagan, an area with a very active EMR Community of Practice led by Dr Jeff Harries. “The South Okanagan area was the first to form a community of practice – in fact we may have invented the concept,” said Dr Hendry. “Dr Harries brought people together and put out the idea of adopting EMR as a group instead of as individuals, so we could help each other out and gain more leverage. Our relationship with the vendor has been stronger as a result, and our user groups are great for support and communication.”
The CoP and user groups are a real boon to local physicians, says Dr Hendry. “At user group meetings, people give updates and share knowledge about how to use the system better. Sometimes it’s just simple tips, like how to find a summary of recent notes; sometimes we learn about new templates or system changes such as e-referral. The secondary benefits of the CoP are very powerful too – although we came together around EMR, it has led to interest in sharing ideas about our practices, improving collegiality, and reducing isolation. When the Divisions of Family Practice opportunity came along, it was much easier for this group to conceive the possible benefits of collaboration.”
When the South Okanagan CoP decided to go with one vendor, all the members gave feedback to inform the final decision. Rosedale implemented its EMR in 2008. The group already had electronic scheduling and billing, but using electronic clinical notes or patient records was new to the practice.
Standardizing Charts
“Moving the data was difficult,” said Dr Hendry. “Each physician had a different style – their paper charts were all different, so each person faced different conversion challenges. It took time to move the problem lists, medication lists and scanned items into the EMR. We have learned from seeing each others’ charting, and the EMR has helped us to be more consistent in the way we document things. And of course the charts are now legible.”
Ongoing Learning and Change
The Rosedale team used hybrid systems for a while, referring to paper charts while transferring basic data and charting new visits in the EMR. Although there are still paper charts stored on site, it is rare to have to refer to them now. “The EMR has great potential, and you can’t appreciate the whole thing at once,” said Dr Hendry. “You can get bogged down because it’s unfamiliar – but it’s a constant learning experience. Little by little you learn how to take advantage of the system’s capabilities, such as population management and chronic disease tracking, rather than just recreating your old paper record.”
Dr Hendry feels strongly that change is good. “Things change all the time – it’s an endless process, just like medicine itself,” she said. “Everything is a moving target as knowledge expands – protocols change, accepted wisdom changes, medications change. The EMR has to be able to adapt continuously. There’s an ongoing need for communication among all stakeholders—users, practice support programs, data providers, and vendors – for a successful product to evolve.”
She knows she’s lucky to be working in the Interior Health Authority region because it has been able to link its data to the EMR. “We get real-time labs, consults and dictations going straight into the EMR. It’s a fantastic change from the old way of doing things.”