Home Forums Discussions General Discussion A New AC Friend From the Great White North

Folks,
Here are copies of PM's I started with a fellow AC user Named Karl from North of the Boarder. I felt we might have a lot to teach each other and share about healthcare on both sides of the boarder. Everybody Give Karl a nice big AC User Board Welcome....

Hey there,
My name is Paul and I really am a USA Hockey registered Official here in NYS. How are you my northern friend? I am also my wife's practice manager and we are about as fed-up as can be with the business of healthcare here in the states.

We down here frequently hear all sorts of horror stories about how things are done up there on your side of the northern (southern?) boarder. I think that many of us down here would love to hear from a real practicing Canadian doctor as to what the real scoop is. Might you want to get into this? I think it would be very enlightening and helpful.

Question: a fellow user that posts here regularly, ROY, was talking with some Canadian providers a while back, and he reported that you guys are only allowed to pick from like five govt approved EMR's... Is this true? Also if it is, can I ask what you are doing here on this American EMR website? Are you too doing research as to how things are down here? Again I think we could help teach each other a lot and perhaps if you are game, we could take this to the public side of the board and start a good thread on the general discussion section.

Anyway, thanks for you time and hope to hear from you soon...
Paul

Karl's Reply to me.....

Hi Paul,

I've been a lurker on the boards for awhile now and finally registered after buying into the program.

I played with this for the better part of a year to see how it would fit into my practice. While I found it didn't speed me up all that much, it certainly made for better notes, better tracking of meds and patients seem impressed. I hope it helps to keep the lawyers away (from my bad note taking, that is......).

Things are certainly done differently up here and I see benefits and problems with health care on both sides of the border.

Where I live (Newfoundland) there is a combination of salaried and fee for service (FFS) practioners. We have very tight rules on billing FFS and these are set through our provincial association in collaberation (?spelling) with the provincial government. The main problem is that each province gets funding based on population from the federal government and the provincial government matches that amount. The association then tries to hammer out a deal and assign dollar amounts to the different kinds of visits. All-in-all, our FFS rates are pretty bad here. For example, a dentist here gets more for looking at a sore tooth in a kids mouth that I would get for a regular visit to handle disbetic recheck and a sore back and an ear ache.

Universal health care is definately a good thing for the patient (except for horrendous wait times for investigations (eg. CT/US/MRI/Specialist appointments) Universal health care is not so good for the Family Doc. We are paid the least of any type of doctor but probably have the highest expenses. To off set this, most of us stretch ourselves too thin. For example, a typical morning starts at 7:00am at the hospital to look after my inpatients, then back to clinic to work till 5:00pm booking 6-8 patients per hour. Then we do 2 twelve hour shifts in the ER and 1 overnight as the hospitalist (look after all the inpatients)per week. You can see why I say my notes stunk. At least this way I can document the notes far better than writing them.

With respect to EMR's, each province is responsible for this. A good example is Alberta vs. Newfoundland. They have some grants to help their docs switch to one of their chosen programs. Here, we have no regulations as to what program to use (at least not yet).

Here, there are not nearly so many players at the table. I probably only have a few "Canadian" choices. An open source project, like OSCAR (I'm not into programming....), MyNightingale or Wolf Medical. My issue is definately value for my money. In meeting their reps I learned to dislike the big EMR companies. They wanted approx 60K to hook up my clinic (solo practioner) and then 7K/year for access to an ASP (ha,ha......). They were cumbersome to use and not intuitive to use easily. I like the layout of Amazing charts, it's simple enough to be useful and intuitive enough to use "out of the box". While it's not as powerful, it is definately worth the money.

I would love to learn how to connect with out lab (uses a meditech system) and download lab results, instead of scanning them all. It's a boring job for the wife and my secretary.

Totally off the topic, I was reading about some posts about people advertising etc to try and build up their practice. I found that amazing. When I started here 5 years ago, I put one sign at the local ER and one at my friends clinic (I worked there as a resident) about 2 weeks prior to opening and had full days ever since. I've basically stopped taking new patients because I have approx 2500 active charts and 750 on a wait list to join the practice. (Do you want a few.....I could ship them down.....real cheap. )

Are there other canadians out there on the board or part of the Amazing charts family?

If you want to post these two messages onto the board, go ahead.......I'd love to meet a few more of the crew.

Later

Karl
--------------------
Solo practioner
Newfoundland, Canada

Karl,
Let's take this to the masses. I have a question for you for starters. We here in America use the AMA coding system for billing and ICD-9 for diagnosis and these codes are a big part of charting and invoicing with AC. I was under the impression that you Canadians used your own system of codes for all of these types of things. So are you only charting with AC and generating all your bills, invoices and diagnosis code stuff in some other format or program? Or does you NF accept the AMA and American codes that AC generates? Or are you using Canadian based codes in some other Practice Managment program and doing the old double entry thing?

Folks,
To all our friends in primary care on this side of the boarder like my Nancy, I think we need to heed Karl's lessons here. The road to financing healthcare for the masses is thru reduced economic and professional respect for PCP's who are really at the heart of any decent healthcare delivery system. The societies and the AMA that should be representing you are doing a lousy job as proven by the awful state that exsists here today. These folks were asleep at the switch for that last 20-30 years, fiddling while Rome was burning, wathching out for your better paid specialist friends. You guys need to form a business and healthcare group that combines, Internal Med, Peds, and Family Practice to represent yours and your patients needs and quickly. A PCP only group that understand the unique issues relevant to your practices and businesses.

Anyway, let's all say Hi to Karl and welcome him and any others from the Great White North to our jolly little group.

Paul

Welcome, Karl!

You are certainly welcome, and thanks for the unique perspective you bring to the User Board!

If we can help in any way, please let us know.

Hello Karl,

I just read my wife/nurse your work schedule and she said "I'm so thankful for what we have." I practice 5 miles from the B.C. border and I know what you're talking about. Many of the BC docs that can, practice down here in "the states". My 250 bed community hospital is listed in the top 100 hospitals in the US for its Cardiac and Orthopedic programs. Our cardiologists host an annual cardiac symposium whose keynote speakers have included former US surgeon general C. Everett Koop. How is this possible in a town of 60,000? Because of the flood of Canadian patients with cash (now at par!) coming down for specialized care they would wait up to 18 months for in BC. Half of our nursing staff are Canadian citizens and we're still 90 nurses short of being fully staffed. When I toured the new cath labs with 5 Canadian cardiovascular surgeons, two comments stuck with me: 1. "We work in a broom closet compared to this." and 2. "In Canada we're all equal, but I've never seen a politician on a waiting list." Nice to know our politicians don't have a monopoly on hypocrisy.

Seriously, though, if I worked your schedule I would find a new line of work. If you can drive a truck, they're paying $50/hr in Calgary right now. Heck, Taco Bell is hiring at $14.

If you're planning to take a vacation, (I'm sorry, I mean go "on holiday" for the 2010 Winter Olympics in Whistler, be sure to stop by for a look at the Other Side.

Dave

Hi again,

We use the same ICD codes (but we don't subtype them as much as you guys.) eg no 781.1 or 781.2 etc we only use 781.

For billing, we can't use the AMA codes at all. I went into the admin functions and added our most common ones. I even went for quick picks to make it easy for us. Unfortunately, the NF government are very picky about their billing program and use an archaic program of their own design and will not branch out. We do a daily batch and my wife enters the codes into the government program to submit electronically to them. A little duplication of work but not too bad.

I find it very intersting reading about how we share some of the same problems, yet others are totally different. I think that it great that this forum is so open and everyone likes to discuss just about anything. I'm sure we will get to know each other over the coming months.

Great to be here, hopfully everything runs smoothly for me with the program.

Later

Karl

Karl,
Thanks so much for your perspective on things from up your way. I think it is so important for folks to go into something eyes wide open instead of eyes wide shut as the saying goes. You are confirming many of mine and my wife Nancy's fears about universal healthcare as much as I am very left of center on most things. One can not perform band-aid socialism while we all still live, work and have to do business with others in a capitalist economy. Worse yet, is the how to bring healthcare to the masses is to exclude the docs who worked so hard to become good docs and to devalue their work and the payment. Well it was valuable enough to pass laws and control prices, then it is valuable enough to properly compensate and professionally respect those who do the work, right?

I just did a Tourney here this weekend and there were a lot of Canadian teams and famlies here and although they were extremely loud, they were loud in a freindly way really supporting their kids and their teams. None of the really nasty, ugly garbage we get down here from our families. I really like the Canadian way to being humble and supportive in sports instead of this ugly urban attitude that has taken over here in American sports. And your coaches were such gentlemen the entire time too. Not one harsh word or tone of voice in any of the four games I skated this weekend. We could learn a lot about how to behave better at youth sports, all sports for that matter from your fellow citizens. Now if we could only reform healthcare for both countries in a way the still respects the providers of the care...

Read my thread on "She should have gone to Cornell" and let me know what you think.This thread is doing just what I hoped it would. Let's keep this going folks.
Paul