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St. Michael's cardiologists develop records system that meets the needs of their patients

Toronto, February 20, 2013

By Leslie Shepherd

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Dr. Paul Dorian and Dr. Iqwal Mangat using EP care system.

Cardiologists at St. Michael’s Hospital have developed a way to get doctors the information they need most about patients faster and more efficiently.

Physicians, especially specialists, have only minutes to spend with patients during each appointment. But too many of those minutes are spent trying to look at a chart or log onto a computer, entering multiple passwords, confronting error messages or clicking through files in search of the latest test results -- time taken away from examining or talking to the patient.

“What patients want is a doctor who looks them in the eye and listens and is not looking at a screen the whole time,” said Dr. Paul Dorian. “The problem in health care today is not a lack of information, it’s too much information that’s not readily accessible.”

Dr. Dorian said the paper chart for a typical cardiology patient at St. Michael’s used to be about as thick as a phone book. Now that such records are kept on computers, each chart holds the information found in many telephone books.

But many of those electronic records are kept in many different systems that are organized in different ways and don’t communicate well, even inside the same institution, he said.

“It’s like a Tower of Babel. They may be speaking one language but six dialects and you have to know all six dialects to have a conversation,” he said. “In addition, every one of those ‘phone books’ in my computer may be indexed differently. Some are listed A-Z, some are Z-A and some are sorted by category. It’s like a restaurant listing. Sometimes they are by neighbourhood, sometimes by cuisine and sometimes by price and if you know how they are listed it’s easier to find what you want.

Dr. Dorian and his colleagues at St. Michael’s, which has one of the largest arrhythmia services in the Greater Toronto Area, have helped design a new electronic records system that meets the specific needs of their patients, most of whom have pacemakers or defibrillators. He said he believes it’s the only system of its kind in Canada.

The system, known as “EP Care” (for electrophysiology, the diagnosis and treatment of the electrical activities of the heart) combines all of a patient’s outpatient records in one place – everything from diagnosis to procedure notes, technical specifications of implanted device and their serial numbers, any complications, and follow up notes.

It’s also basically an app, which both sorts information faster and more efficiently than anything else on the market and displays the information cardiologists need most often in a convenient dashboard format.

“Imagine you are an English teacher and you teach the same Shakespeare class every year requiring the same six reference books. What if there were a robot who knew to search the library every semester, find those six books and put them on your students’ desks ?” Dr Dorian said. “Our program is similarly designed to emulate our workflow, bringing up the same key files every time we see a patient, such as issues related to their pacemaker, for example. Instead of the physician spending time looking for the important files, the system knows what you want and displays it on a dashboard.”

Dr. Dorian said the other novel aspect to EP care is that it was designed by users – the physicians, nurses, technicians and administrators in the cardiology program – working with the hospital’s IT Department. They then hired a vendor, B Sharp Technologies, to build it