Dr. José François, MD CCFP Dip Med Ed
Centre de santé St. Boniface, Winnipeg

My ERM experience
Centre de santé St Boniface is a community health centre located on the campus of St Boniface General Hospital. The Centre serves residents of the St. Boniface neighborhood as well as the French-speaking population of Winnipeg. Since its inception, the number of health professionals working in the centre has grown and now includes: five family physicians, two nurse practitioners, two primary care nurses, a dietician, a social worker, a mental health nurse, a part-time psychiatrist, and a community outreach worker. Since 2005, we’ve also been a teaching site in the University of Manitoba’s Family Medicine residency site and welcome three family medicine residents and multiple medical students every year.

EMR from day one
Centre de santé started with an EMR on day one when it opened in the summer of 1999. Due to limited space, there was little room to store medical records and as all the staff was new, there was an opportunity to train everyone prior to them starting their practice. Unlike other practices, we didn’t go through the transition from paper to electronic records.

Choosing the right system
The choice of EMR was made by our clinic’s administrator, as clinic staff (physician or other) had not yet been hired. In 1999, there were a limited number of software vendors and relatively few other clinics had instituted an EMR. After investigating a number of vendors, a local vendor was selected as it provided Manitoba Health-compatible billing software and supported an EMR from a national company which it represented. Although medical staff were not involved in the initial selection process for the EMR, many of the functionalities we were looking for were present: electronic prescribing, medication interaction/allergy alerts, well laid-out dashboard, ability to trend results and customize templates.

Upgrades to hardware and software
Over the years, software upgrades have improved functionality of the EMR but this has not always been without problems: temporary interruptions in service, system “glitches” and inadequate hardware to support software. We’ve also had to plan for replacement and upgrade of hardware (servers, computer stations, monitors, scanners, printers). In addition, we’ve had to endure a “divorce” between our local billing software provider and the national EMR provider which resulted in having to deal with two different companies for our needs.
We have had our challenges, but none of our physicians would go back to paper charts.

Over the years, we learned a few lessons:

1. Think about what you want your EMR to do: scheduling, billing, charting, trending results, electronic prescribing, off-site access.
2. Look at what EMR other practices in your region are using.
3. Look at how your EMR can connect with labs, x-ray, hospitals, pharmacies in your region.
4. Ask about the local support of the product.
5. Ask about the upgrades, when, how and how much.
6. Make sure that you schedule enough time to train new users.
7. Identify a person in your office who will be the main contact person with the EMR vendor, IT provider, internet provider, etc.
8. Think about how the EMR will change the workflow in your office.
9. Don’t hold on to paper! – store paper charts after about six months, scan documents into the EMR, have lab results sent electronically if possible.
10. Schedule time for regular refreshers courses.