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Local doctor a pioneer of electronic medical records

In the early days of the north's foray into electronic medical records, Dr. Bill Clifford would drive to doctor's offices with printers and scanners stacked in his trunk, eager to impart his love of intelligent software systems.
Dr. Bill Clifford has been developing a medical record system since he was in medical school. The system is used throughout the province. Last year Dr. Clifford received the Order of British Columbia.

In the early days of the north's foray into electronic medical records, Dr. Bill Clifford would drive to doctor's offices with printers and scanners stacked in his trunk, eager to impart his love of intelligent software systems.

Even as he managed his own practice, Clifford was developing codes on the side to improve approaches to patient care.

That system, dubbed MOIS (for Medical Office Information System), means doctors can pull up patient information in a matter of seconds to view a full history of tests, medications, allergies and more.

"You don't miss things," says Clifford, highlighting its ability to flag for tests specific to a patient or given their age or gender. "It prompts you to do some of the screening maneuvers or prevention maneuvers that you might otherwise forget, especially if someones coming in for something simple."

As important, the data can be analyzed to get an image of health in the north and how its medical professionals are performing.

It's no surprise Clifford cares how MOIS is used: he built it.

"It's all about the patient," says Clifford of MOIS, which transitioned from mostly a billing model in 1990, to fully paperless by 1995 and by 2008 brought Northern Health on board when Clifford sold it to a non-profit society for $1.

Today MOIS is in all Northern Health's primary care clinics, regional hospitals, as well as more than 60 per cent of the north's private clinics. When Clifford was awarded the Order of British Columbia last year for his work in medical software, MOIS was ranked the number one record system in Canada.

"It works very well. It's highly integrated," says Jeff Hunter, Northern Health's Chief Information Officer, adding the ability to exchange information between Northern Health's separate systems is extremely valuable.

"(If) a report is done by radiologist that information is almost instantly available in the electronic medical record in the physician office now," says Hunter, noting that for privacy and functionality considerations, Northern Health uses several electronic medical record (EMR) systems for acute and community care.

But Clifford by no means takes all the credit.

"It's all a communal, collaborative effort," he says of MOIS, which now has more than 2,000 users, including some in Vancouver Island. "The non-profit basis is one of the things that really stimulates that because the motives are 100 per cent behind the quality and satisfaction of the group and of course, first and foremost the patient-centered care."

Clifford first noticed medicine's technology gap when he during his first year in medical school in New Brunswick.

He'd just left his career in forestry and resource management where he regularly worked in digital mapping and quickly realized that in the area of software systems, "medicine was primitive."

By the time he moved to Manitoba for his residency, he decided to do something about it.

"It became absolutely clear to me that this was ridiculous, that we needed to have electronic medical records," says Clifford.

Fast forward to 1995, the start of a two-year triumph for the system, when Clifford developed "control H," a hot-key combination that gets MOIS to analyze.

"It's this functionality that does a review of the chart by age, gender, specific items ... (like) cholesterol screening requirements, vaccinations for individuals of certain age or gender."

It also sifts through a list of problems - like diabetes - and if it applies to the patient provides further prompts.

"So in one view you can see how the patient's doing in multi-dimensions at a glance to decide what needs to be done," Clifford says.

The second revival in the system's development came in 2008, when he gave up control of MOIS.

"It wasn't about the money. I was shopping around trying to find the best parent to hand this child over to," says Clifford, who wouldn't give exact price quotes citing confidentiality but said some offers topped $100,000.

Selling out, he feared, wouldn't ensure its continued development. Neither was open source the right approach.

"What happens if nobody gets caught up in the dream and development doesn't happen?"

So, he went with the third approach and formed a non-profit society - the Applied Informatics for Health Society (AIHS) - and sold it to that group for a loonie.

"I didn't see the dollar for some time," he adds with a laugh, adding that covered the cost of its intellectual assets including software codes.

"I was in the luxurious situation of being able to literally throw out all of these ideas that I would have been working on serially over a large number of years to achieve and start seeing things coming together much faster.

"The rest is history."

That history has meant better patient care in the north.

For example, it's improved screening methods for HIV in the last five years. An audit found that only 19 per cent of patients were tested for HIV when they came in for sexually transmitted infection or blood-born pathogen checks.

"There's no reason they shouldn't be also tested for HIV," he says.

"We've actually increased that to just under 50 per cent across a large number of practices," says Clifford, adding some are in the 70 to 80 per cent range.

Then there's the ability of the system to allow its users to compare their results to other offices and to

Overall, in the north they saw a 25 to 30 per cent improvement in performances on all measures, he said, simply by from using the system.

It also led to the development of another system called Aggregated Metrics for Clinical Analysis Research and Evaluation (AMCARE) in a collaboration between Northern Health and UNBC.

It means information can be exported without sensitive patient details to help give a picture of care - and population health - in the north.

And there's also the ability, in MOIS, for doctors to share their performance with patients.

"You can see graphs of how you're doing compared to your colleagues," says Clifford. "It's really fun to watch two doctors go head to head looking at their data."

Hunter gives the example of doctors at two practices comparing responses to patient requests for appointments. One office might book within days, while another takes a week.

"Then they go and have to change their practice to make access improved and it ultimately benefits the patients," he said. "There's all kinds of examples like that to effectively improve care for the patient."

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