Dr. Johann Blignaut, M.B.Ch.B.
Dr. C.W. Wiebe Medical Centre, Winkler

My EMR experience
The Winkler Clinic obtained electronic medical records in the spring of 1999. If memory serves correctly, we were one of the first clinics in Manitoba to use a full EMR. We had used software for billing and scheduling purposes for several years prior to this, but paper files were still used to store patient records.

Significant change and growth
Our acquisition of an EMR came against the backdrop of significant change in our community. The population of our region was rapidly growing (and still is) and the clinic itself had just recently experienced significant growth. In 1998 the clinic doubled its number of family physicians from five to ten. Today the Dr. C.W. Wiebe Medical Centre has 20 family physicians and three specialists with approximately 23,000 active patients on record. (Active patients are those who have a family physician at our clinic and were seen within the last 18 months, as defined by the PIN project.)

It was clear to us that computerization was inevitable and we thought the sooner we implemented this change the better. We were running out of room to store the paper charts and chasing them down when needed became a full time job. The ability to read each other’s notes, the ease of accessing and comparing lab results and legible prescriptions were some of the draw cards.

Short listing vendors
We compiled a short list of three vendors. The vendor we went with was able to provide everything we needed at less cost. We liked the fact that it was Windows based and therefore user-friendlier than the DOS based systems we had used in the past. The company provided excellent product support and training. A technician was available on site for a month after the installation and thereafter help was a phone call or e-mail away. The estimated two-year cost was about half of what it would have cost us if we went with the vendor that used to provide our billing and scheduling software.

All of us remember the first six months after installation as a stressful time. There was a sense that productivity declined initially. Each of the physicians bought their own laptop computer. We had to shut it down and start it up when moving from one exam room to the other. This was extremely frustrating and inefficient. Later we acquired a desktop computer for each room and this set up worked much better.

We decided to dictate letters, but to type clinical notes. Some of us “dusted off” our typing skills, others learned to type with Mavis Beacon. As our typing speed and comfort level with the software improved our efficiency improved.

Technical support and ongoing training
A full time I.T. technician was employed early on. This person is responsible for installation of software updates and the general maintenance of the system. He is a valuable resource when problems crop up. Ongoing training for new and established users is essential. We schedule regular “computer sessions” where problems are discussed and we learn from each other.

We now have a broadband connection between the clinic and our local hospital that allows us to use our EMR when working in the hospital. This has helped to enhance continuity of care for our hospital patients. X-rays that are done at the clinic are sent electronically to the hospital to be viewed by radiologists. It enables us to discuss an x-ray done at the clinic with a radiologist when the need arises.

Some things that seemed intuitive and easy to set up took longer than expected. From the outset we had hoped to receive lab results and discharge summaries from the hospital. Unfortunately, with respect to lab results, this only became a reality about one year ago. The interface with the hospital and other facilities remain problematic due to compatibility issues.

Computerization of a medical practice involves change at many levels and change involves stress. But despite the initial aches and pains and the occasional glitch that are part and parcel of using technology we feel it was one of the best decisions we have made. It’s probably safe to say that none of us can imagine managing our practices without it.