Continuing Education
Improving Patient Care
and Sales Performance
with Electronic Medical
Records (EMR)
About The Author
This course has been prepared for the Council for Continuing Pharmaceutical Education by Dan Palfrey. Dan has senior and executive experience in both the pharmaceutical and electronic medical records (EMR) industries. He has held progressive leadership positions with a multinational pharmaceutical organization in market research, sales, marketing, product management, and government relations, and most recently, had been a vice president at one of Canada's leading EMR companies. Dan holds a Master of Public Health from the University of Alberta, and has been a recipient of the Robert Wood Johnson Award.
Table of Contents
Introduction and Course Overview 7
CCPE Course Rationale ... 7
Focus of This Course ... 8
Objectives of This Course ... 8
Clarifying Definitions ... 8
Course Overview ... 9
Module 1: EMR Technology Overview 11 Learning Objectives ... 13
Introduction to EMR Capabilities ... 13
How EMR Can Improve Clinical Care ... 14
Benefits of EMR Use in Canada ... 14
Table 1: Current and Emerging Benefits of EMR Use in Canada ... 15
EMR Capabilities to Support CDM and Preventive Care ... 16
Figure 1 – Percent of Physicians Estimated to Realize Benefit by Area ... 17
Key Summary Points ... 18
Module Progress Check ... 19
Module Answers ... 20
Module 2: Overview of the Canadian EMR Market 21 Learning Objectives ... 23
Introduction ... 23
Provincial EMR Deployment Models ... 24
Figure 2 – EMR Adoption by Province ... 26
EMR Deployment by Province... 26
Major EMR Vendors ... 33
Figure 3 – Major EMR Vendor Market Share 2015 Estimate by Province ... 34
Key Summary Points ... 36
Module Progress Check ... 37
Module Answers ... 38
Module 3: Current Capabilities and Maturity of EMR Utilization 39 Learning Objectives ... 41
Capabilities of EMR ... 41
Limitations of EMR ... 44
Maturity of EMR Utilization in Community Practices ... 45
Table 2 – Measures of Utilization Maturity ... 46
Figure 4 – PITO Clinical Value Model ... 47
Figure 5 – EMR Meaningful Use Model ... 48
Key Summary Points ... 50
Module Progress Check ... 51
Module 4: Future Capabilities of EMR 53
Learning Objectives ... 55
Introduction ... 55
Data Sharing & e-Referral ... 55
Patient Portals ... 56
e-Prescribe ... 58
Staying Current with Innovation ... 58
Key Summary Points ... 59
Module Progress Check ... 61
Module Answers ... 62
Module 5: Principles of How EMR Tools Improve Care 63 Learning Objectives ... 65
EMR Tools to Improve Patient Care ... 65
Figure 6 – Conceptual EMR Tools ... 66
Principle 1 – EMR Tools can be Retrospective ... 66
Figure 7 – EMR Screenshot – Retrospective Tool ... 67
Principle 2 - EMR Tools can be Opportunistic ... 68
Figure 8 – EMR Screenshot – Opportunistic Tool ... 69
Principle 3 - EMR Tools can be Intentional ... 70
Figure 9 – EMR Screenshot – Intentional Tool ... 71
Tool Development & Deployment... 72
Considerations for Representatives ... 73
Key Summary Points ... 74
Module Progress Check ... 75
Module Answers ... 76
Case Study 77
Introduction and Course Overview
CCPE Course Rationale
The potential for electronic medical records (EMR) to improve patient care is very important for the life sciences industry. Effective implementation of various EMR decision-support tools permit healthcare professionals to better provide evidence-based care, which will often have a direct,
positive correlation on the prescribing of appropriate therapies, especially newer
innovations. In many therapeutic categories, there often is not a knowledge gap (what to do per
the evidence or clinical guidelines), but rather, an action gap as physicians are without tools to support them in putting evidence into practice. This action gap can result in sub-optimal utilization of innovative therapies. EMR is an important technology to close this gap.
This CCPE course provides an overview of the Canadian community-practice EMR market for Canadian medical representatives. The course provides education in customer support with a goal of better utilization of EMR for the benefit of patients, physicians, and industry.
A thorough review of EMR within Canadian community medical practice is timely, as use has increased significantly in the last decade. In 2007, only 32% of primary care physicians used EMR. The adoption rate has increased significantly since then and is now 80% and growing1. When used with a level of maturity, EMR is much more than an electronic version of a paper chart. It can serve as an information system to help providers and staff preventively, proactively and reactively improve clinical outcomes. Through the use of search-and-recall capabilities, providers can identify patient populations of interest and initiate recommended care such as screening or vaccination. Providers can integrate evidence into practice through the use of tools like
documented care plans, evidence-based encounter templates that mine EMR for contextual data (e.g., latest HgA1c for a diabetic visit), therapeutic goal monitoring, and strategically placed clinical decision supports and alerts. These tools create the opportunity to provide appropriate and timely care when seeing patients for any condition.
Analyses of EMR utilization have shown that physicians are not using EMR to its full potential or creating the appropriate context for use as a true information system to improve care. However, intervention is able to create improvement and advance meaningful use. There is significant
opportunity for industry representatives to add meaningful value to their interactions with target physicians, help them better utilize EMR, and likely increase prescription of newer therapies. A better understanding of the principles of EMR capabilities will enable physicians to
work in a self-directed manner to build and deploy decision support and other tools, and representatives can therefore add value without requiring access to private patient medical records.
Further, it is important to understand there are advanced capabilities with EMR beyond practice searches and patient recalls (such as future developments like Patient Portals) that will permit representatives to work incrementally with physicians over the long-term to build
Although the market is fragmented nationally and provincially without a single EMR having dominant share, EMRs generally have similar capabilities. Product development has been led by conformance to the same, or similar, specifications that the provinces have generally borrowed from and shared with each other. Thus, there is opportunity for representatives to develop skills to support physicians in the design of conceptual tools that can be built in any EMR environment. Representatives are then in a position to support clients using EMR from any vendor.
Focus of This Course
The focus of this course is electronic medical record (EMR) software at the Canadian community-practice level. It therefore excludes discussion of health information management (IM) and information technology (IT) at the institutional, regional, or provincial level, except as relevant to community EMR deployment.
Objectives of This Course
After completing this course, you will be able to:
Discuss the intended benefits of EMR, the rationale for, current state of adoption, and key vendors in the market;
Discuss the capabilities and limitations of EMR;
Describe the key principles of EMR tool design and development that help healthcare providers improve patient care and the prescribing of appropriate therapies;
Describe the anticipated future state for EMR in Canada in preparation for the changes to come and the opportunities they present.
Clarifying Definitions
EMR - electronic medical records: This term is used to describe practice or provider-level patient
medical record and practice management software. It is more limited than EHR, as defined below, and is the focus of this course.
EHR - electronic health record: This term in the United States is often used synonymously with
EMR; however, in Canada, it refers to a more comprehensive set of health IM/IT resources used to capture and manage health information. The term typically describes provincial level resources, such as pharmaceutical and lab information systems, where the
Course Overview
Module 1 - EMR Technology Overview: This module provides an introduction to EMR and how it
can improve patient care and therapeutic decision-making. It describes current and emerging benefits of EMR and reviews the evidence for its ability to support chronic disease management and preventive care.
Module 2 - Overview of Canadian EMR Market: This module provides an overview of the rationale
for investment in EMR, describes how each province has approached its EMR funding program, and reviews the adoption rate and the major EMR vendors in Canada.
Module 3 - Current Capabilities & Maturity of EMR Utilization: This module describes the key
capabilities and limitations of EMR. It outlines the current state of Canada’s utilization maturity to position its readiness to achieve meaningful improvement in clinical outcomes.
Module 4 - Future Capabilities of EMR: This module describes three key future EMR and
EMR-extension technologies with which representatives should remain current given the potential to create opportunities for providers, patients, and industry.
Module 5 - Principles of How EMR Tools Improve Care: This module presents a model for
conceptual EMR tool development, providing representatives with the skills to work with
physicians and staff using any EMR and support them in implementing tools that improve patient care and appropriate prescribing.
