Canadian doc embraces flexible EMR after shunning template-based system in U.S.

Is the design of the American health system to blame for low EMR adoption? That seems to be the implication in a Technology for Doctors story headlined, "How I learned to stop worrying and love my EMR."

The story chronicles the EMR experiences of Dr. Ronald Eliosoff, 65, a primary-care physician in Ottawa who moved to the Canadian capital from the U.S. four years ago, in part because he couldn't stand the EMR he used in the States. "I had a major problem with it and it was part of the reason that I left the U.S.," Eliosoff tells the Canadian publication. "I had to enter all my clinic notes into point-and-click templates. It didn't allow me tell a narrative story, using the patient's words, which to me is critical."

Eliosoff believes templating is useful for collating information, but not for the practice of medicine. "Almost 90 percent of the information you need comes from the patient's history. But the design of the program was likely mandated by American insurance companies," he says. (The coding and documentation functions help improve billing and allow providers to justify higher reimbursements.)

He moved north of the border in part because he thought he was going into a paper-based practice at Appletree Medical Group, which runs a chain of walk-in clinics. As it turned out, Appletree had an EMR, but it's one that Eliosoff has embraced. The system, developed by an Appletree affiliate and sold as EMR Advantage, offers multiple input and documentation options, including handwriting, dictation, speech recognition and free-text typing, with everything stored in digital format. Eliosoff personally prefers dictation; he edits his own notes after staff transcribe his spoken words.

He's also become a fan of EMR Advantage's clinical messaging and referrals process. "The EMR lists all the ENTs in the Ottawa area, for example, and I can just push a button for the one I want, I can note why by pushing another button, and I can see relevant lab results by pushing another," Eliosoff says.

"The way the system is laid out, it follows the logical processes and steps a doctor would go through to collect information and make decisions about the patient. It's very clear to me it was designed by doctors," Eliosoff says. "I'm a convert now. I find the EMR extremely helpful to the point that I would find it very difficult to practice medicine without it."

So perhaps the lesson here isn't that the U.S. health system is a mess--which it is--but that EMRs must be user-friendly and work the way doctors work.

To learn more:
- take a look at this Technology for Doctors story