Dr. M. Duerksen, MD, CCFP, FCFP
Steinbach Family Medical Center

My EMR experience
In August of 1999 we converted our clinic to an electronic medical record. Our clinic has 15 family physicians and two general surgeons. There were several reasons that motivated us to move to an electronic record.

We were dissatisfied with our paper chart system. Our chart room of over 30,000 paper charts was full. Significant staff time was being spent pulling and re-filing charts and filing incoming lab results into the appropriate charts. Individual patient charts were becoming unmanageable when seeking out relevant information at patient visits.

Another motivation for computerizing pertained to our desire to expand our clinic and we felt an EMR would be attractive to incoming physicians. Overall we felt that by computerizing our medical records we would be improving patient care and physician and office efficiency.

Having decided to go to an EMR system, we developed criteria that we would expect a good EMR to have.

Some criteria we considered:

1. Comprehensiveness of the EMR.
   Does the EMR do everything that is involved in managing a physician practice - scheduling, visit notes (templates), prescribing and medication management, billing, lab result management, consultant report management, generation of consult letters to specialists, address book, "to do" list to keep physicians organized, internal email and instant messaging, remote access to charts.
   
   
2. Integration of the EMR.
   How well are all the above tasks integrated with each other within the EMR? How robust is the database search engine ?
   
   
3. Ease of use, intuitiveness of use.
   Can someone with minimal computer knowledge learn the program with minimal frustration ? Are the features provided likely to be used ?
   
   
4. Effect of EMR on physician work flow and office work flow including staffing levels.
   How adaptable is the program to varying styles of practice ?
   
   
5. Software support and stability of the vendor as a company.
   How responsive is the company to software change requests ?
   
   
6. Cost
   We included initial startup costs of both hardware and software and ongoing support costs and software upgrade costs.

Making the choice
We initially considered three products, when we were choosing an EMR. Our final choice was based on product demonstrations by the vendors, visiting clinic sites that were already using the product and rating the products against the criteria we had established.

Going Live
There is an initial cost of time and energy to organize and pull together an EMR project that is challenging but also rewarding.

The greatest stress in the process was implementation of the EMR. This period of time involved the most amount of change in a concentrated period of time affecting staff, physicians and patients. We had a pre-implementation training day for staff and physicians. For the first week we had onsite support from the vendor with support staff roaming through the clinic helping with the transition while "going live." The transition of working with both paper charts and the EMR for the first several months was time consuming and tiring.

We learned several lessons in working with and implementing an EMR. Being responsive to various degrees of interest and knowledge in the use of computers within staff and physicians was important to accommodate. Being flexible and able to accommodate the world of "computer glitches" is important. Working with the EMR vendor to understand what is needed and what is achievable with a software product is also important.

Integration of our EMR system with our hospital lab to allow for electronic importation of lab results and involvement with the Physician Integrated Network and Advanced Access have increased our appreciation of our EMR.