InfoClin presenting at Information Technology and Communications in Healthcare (ITCH) Conference in Victoria Feb 2009

16th September 2008 - Dr. Karim Keshavjee, CEO of InfoClin Inc, will be presenting three papers at the Information Technology and Communications in Healthcare (ITCH 2009) conference in Victoria, Feb 19-22, 2009.
1. Failure of Electronic Medical Records in Canada: A Failure of Policy or a Failure of Technology?
This paper builds on previous work completed in the areas of EMR policy analysis[1], EMR implementation theory[2] and research done on EMR uptake[3] to propose a critical pathway for EMR uptake and where policy and technology deployment have gone awry in Canada.

The analysis includes a value chain' analysis of EMRs and how EMRs create value for physicians and for society. The EMR policy analysis will critique current EMR implementation policies and point out where failures are occurring in the value chain and how the same mistakes are being repeated across the country.

EMR implementation theory and research on EMR uptake will be used to provide insight into where economic drivers and EMR roll out policies have collided to create poorly aligned incentives, opportunities for cheating and an environment that is keen for uptake, but is paradoxically mired in apathy as well-intentioned programs founder on the treacherous shoals of complex ICTs in health care.

The analysis will attempt to illustrate that the policy failure in Canada is largely due to a misunderstanding of the dynamics of deploying complex technologies into complex organizational settings, the incentives for doing so and the returns necessary to justify continuing investment. EMR investment and deployment policies have been largely based on an erroneous understanding of the benefits of ICT in health care and how they can be realized. This has led to large of sums of money being expended, but poor or inadequate uptake.

The US has recognized the level of the problem and has recently recommended bold steps be taken to overcome these issues[4]. Recommendations for changes in Canadian policy and technology deployment to increase likelihood of EMR implementation success will be made.

[1] Keshavjee K. EMR Implementation in Ontario: A position paper to increase EMR implementation in Ontario. Intel of Canada White Paper. July 2007.

[2] Kucukyazici B, Keshavjee K, Bosomworth J, Copen J, Lai J. Best practices for Implementing Electronic Health Records and Information Systems. In Human, Social and Organizational Aspects of Health Information Systems [Eds: Kushniruk A and Borycki E]. IGI Global 2008.

[3] Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, Kittler AF, Goldszer RC, Fairchild DG, Sussman AJ, Kuperman GJ, Bates DW. A cost-benefit analysis of electronic medical records in primary care. Am J Med. 2003 Apr 1;114(5):397-403.

[4] Nancy M. Lorenzi, Laurie L. Novak, Jacob B. Weiss, Cynthia S. Gadd, and Kim M. Unertl. Crossing the Implementation Chasm: A Proposal for Bold Action. J Am Med Inform Assoc 2008; 15: 290-296.

2. Out with the EMR!:
This paper will present a critique of current EMRs and current deficiencies which make them inadequate for medical care. The analysis rests on recent work done to assist physicians manage information in their EMRs for prevention and chronic disease management care. The paper points out how EMRs replicate current paper-based paradigms and get trapped in the inherent inefficiencies of document- and encounter-centric documentation approaches. We will propose an alternative approach to record-keeping that is more congruent with modern information management requirements, which does not get trapped in a document-centric paradigm and yet is also consistent with the legacy encounter-based approaches required for medico-legal purposes.
3. Developing a Chronic Disease Surveillance Network in Canada: Health Informatics Challenges and Proposed Solutions.

This paper describes the design of an informatics architecture to extract data from community-based EMRs to a central data repository. Challenges encountered, including un-coded and unstructured data, poor meta-data binding and incomplete data will be described. Approaches to improving data quality when data comes from multiple EMRs, each with a proprietary database, and multiple physicians, each with different charting habits, will be proposed. Improvements to EMR functionality to facilitate data capture will also be proposed.