It has been a bit of time since I last posted anything on OSCAR in Alberta!
Lots has happened!
I have been approached by several new EMR software vendors that intended to start operations in Alberta. I have been asked to evaluate their software and to comment upon my opinions. This was exciting because in my opinion - more competition is good for everybody!
The software that I reviewed was overall pretty innovative, but in my opinion - overly "templated", which in my opinion takes away the incredibly valuable "human component" of the record of patient interaction.
"Template" EMR's also increase the risk of factitious or erroneous information and - while tempting to use - do very little to contribute to quality patient care.
There is really no value in "template" records in EMR software. One would think that recording a ream of "pertinent negatives" (that were never "really" checked on) would minimize medical-legal risk. That is totally untrue.
Colleges and even Lawyers are now educated enough about "template" EMR records, that "template EMR's" have become a risk for liability in keeping EMR records. Template EMR records are a big stinky red flag for College investigators and lawyers (all smart people), that suggests that you are more interested in "efficiency" than in quality medicine.
This is ironic in Alberta, where Government seems to often prioritize "efficiency" over "quality" in medical care - but you have to let Government sort through this all to eventually get it right. In truth, Government will ultimately take inspiration from the Physicians that actually DELIVER health care.
The fact is that we "SET THE TONE AND STANDARD OF QUALITY" in medical care, and we cannot afford to get lulled into accepting low-end, robotic recordings of a Physician-patient interaction (found in many EMR's).
I recently took a course on Humanism in Medicine. I went into the course, feeling a bit cynical at my role in Medical Care, and frustrated with the fact that I am spending more and more of my time as a patient advocate - battling anything and everything run by Alberta Health Services - than actually practicing my profession. Not that Alberta Health is the "enemy" - they just have the impossible task of increasing demand for dwindling resources. The potential for conflict between Patient advocates (Physicians) and the Administrators of these resources (Alberta Health) is inevitable under the current administration of health care.
The course on Humanism in Medicine simply rocked my world.
I was "reintroduced" to Medicine as wonderful combination of Art and Science that defies adequate explanation. I was "reminded" to return to the "humanistic roots" of what drove me into this wonderful career in the first place, and shown how I had become drawn into bottomless pit of the "Race to the bottom line" that has become the mantra of Provincial Health Administrations in Canada (and of Health Insurers in the USA).
The fact is that modern medical care requires Family Physicians to be tireless, fierce and proud advocates for their patients - without regard to income, consequences, pressures, doubts or fears.
So when I returned to practice with my newfound resolve to practice "humanistically", magic happened!
I still got paid. I still got tired, I still got frustrated. But I was way happier.
My patients felt better cared for and I no longer romanced plans for retirement or a switch to another career. I'm not making as much as I think I should - but I don't spend money like an idiot and I pay my bills, save for retirement and can afford bully sticks (damned expensive) for my little buddy, Higgins (emotional support puppy who works in our office to calm down kids and other patients in need).
This is Higgins
Oops. I digressed!
What I was getting at, is that "template medicine" has no place in a Physician's EMR. One can make small templates that remind one to question a patient about certain important items - ie. depression in a postpartum check, etc. But "pre-filled" templates are irresponsible and probably unprofessional in my humble opinion.......and in the opinion of smart people in the "know" (see here). Even the Colleges agree (at least the CPSA does in Alberta).
OSCAR remains template-free in its essence. One can make custom templates, but they have to be "made" by you - and they can be made and used as a tool to jog ones' memory. The "toiletpaper roll" in OSCAR where one records their "SOAP NOTES" is old school, effective and captures your impressions as a Physician.
I have learned to dictate into my SOAP notes "live" by using my MacBook Pro to auto-type as I speak. I speak my impression and lots of ancillary observations into my OSCAR notes using the voice dictation features available through any Mac OS (Windows has this too).
This is done in front of the patient, and I include notes about the patient illness experience.
The gratitude and completeness that the patient feels with this approach, is considerable. I also occasionally offer to print a copy of the office visit for loved ones in cases where the patient's memory may be past its "best before" date. ;-)
Very, very few EMR's allow this kind of "natural" interaction with patients that is facilitated by the EMR. In fact, most EMR's actually discourage this - wanting to instead have us act like robots.
Perhaps this is why OSCAR is really taking off in Alberta. I am excited to witness more and more consultation requests coming into my Office Surgery Clinic daily from OSCAR users in Alberta.
The success of OSACR in Alberta is probably driven by the old "slow and steady wins the race" mantra. The Government support of Physicians adopting EMR's (POSP program) is now gone. This means that Physicians are getting fleeced by their EMR companies (ie. Telus's WOLF EMR) for low-end EMR's that encourage "low end", "robotic" EMR interaction.
Not OSCAR.
OSCAR remains the EMR of "Humanists", and it seems that a growing number of Physicians agree!
More soon!
ps. Oh! And those EMR companies that I evaluated? All gone. No responses from anybody. No marketing, no follow-up interactions.....nada......their profit models are broken. That is why OSCAR will likely be the "last man standing". It is not owned by anybody - there is no "profit model" for OSCAR. You pay a good vendor to take care of you - and then you just take good care of your patients. What better model for an EMR could there be?
Feel free to comment on your questions, concerns and criticisms!
