Into what seemed a mature market, two FPs designed a new EMR—and 230 clinics have signed up

Most family doctors who are unhappy with their EMRs are too busy to do anything about it, but that wasn’t the case with two family physicians, Drs. Mike Forseth and Matt Henschke of Calgary, who began designing their own EMR in 2016. Today, the Ava EMR is used by 230 clinics in Alberta and B.C., defying a stranglehold the big three vendors have on the Canadian market.“When Matt and I first met, we were both disappointed with the state of EMRs,” recalled Dr. Forseth, CEO of Ava Industries. “A lot of them were pretty old and we knew there were things we could do to improve them. It started as a fun weekend project and grew from there.”“We tried seven or eight EMRs and with each of them there were some things we liked and some that we didn’t like,” added Dr. Henschke, president and chief visionary officer of Ava Industries. “None of them brought the whole package together, so I started teaching myself programming.”When Drs. Forseth and Henschke opened their own clinic, their Ava EMR had its first customer.Read: Dr. Melissa Yuan-Innes: The worst electronic medical record system!Design philosophyEfficient workflow was a key factor in their design philosophy. “One of the things that drove me nuts when I was practising in clinics with other EMRs was having to jump between different screens or pop-ups to do the same thing over and over,” recalled Dr. Henschke. “We figured it would be more efficient to do 80% of our work from two screens. For the 20% of cases in medicine that are more complicated, sure, it takes a bunch of clicks to get those done, but that’s OK because you’ve optimized the other 80%. That design philosophy has trickled into everything we do.”Another important part of their design philosophy is the avoidance of bolt-on, peripheral functionality like patient portals and AI scribes. Ava has AI scribe and patient portal functionality built into their EMR.“We have 120,000 patients tied into our clinics through the cloud,” said Dr. Forseth. “They have full access to their records through Ava Connect, our patient facing app. They can log in and literally see everything in their chart, all their lab results and their entire health profile. They can book their appointments and message their clinics. No other EMR offers that functionality.”The same design philosophy of avoiding bolt-on functionality prevailed when AI scribe technology showed promise as a means of alleviating the data entry burden faced by doctors. Built in-house, Ava Scribe is fully integrated into the EMR space, “so we are able to take the context of the chart, the templating and the workflows that the clinician and the clinic already have and actually integrate the scribe into them, so it complements that workflow,” explained Dr. Henschke. “For most of the competing products out there, you’re still cutting and pasting into your EMR.”Ava also has eFax capability with an accompanying AI application built in-house that categorizes and identifies incoming faxes and assigns them to the right patient chart. Clinic staff save up to 10 hours a week of drudgery by not having to read every fax. Instead, they just have to confirm what the AI application picks up.Read: The great AI scribe rolloutData migrationDrs. Forseth and Henschke, who both still practice medicine, were mindful of the data migration risks when switching EMRs—especially in Alberta where there were a lot of vendors that failed, forcing clinics to move to new products.“A lot of those early migrations were terrible, and a lot of data was lost,” said Dr. Forseth. “There were a lot of traumatized docs out there who never wanted to move again. ‘We’re not going through another migration,’ they told us. ‘I never want to do that again.’“A lot of legacy systems have database engineers or someone who understands data, but not medical data. We invested a lot in this when we started with our first customers, so we do a better job with data migration than almost anyone in the industry. That’s because we have a dedicated approach to making sure the data moves properly.”Ava also eases the transition to a new EMR by following a robust onboarding and training process that includes the assignment of training staff the clinic is already familiar with for a month following go-live.Clinicians requiring support on an ongoing basis can turn to Ava Academy, an online resource and knowledge base. “Doctors don’t have a lot of time to learn everything about a new system. They’re busy looking after their patients and need quick, simple answers to the problems they have with their EMR,” said Dr. Forseth. “We have a great feedback mechanism from our customer support people. They note every ticket they get, and for the tickets that come in repeatedly they build new articles for our Ava Academy. We also do webinars and issue regular communications about feature releases and improvements to the EMR.”Beyond Alberta and B.C.Drs. Forseth and Henschke would like to expand beyond Alberta and B.C. but face a barrier to entry in other provinces. “One of the biggest challenges is that each province is its own separate health system with completely different integrations for labs and billings, and some of them like Ontario have gatekeeper organizations like OntarioMD,” said Dr. Henschke.“You can have what the market feels is the best product, the most efficient product for your practice, but that doesn’t necessarily mean—in the case of Saskatchewan and Manitoba, for example—that the government will put you on their approved list.“We poked around at a cursory level to see if other provincial governments are willing to accept a new entry and it was hard, so we decided to focus on provinces we know for sure we can integrate with and where we can be a competitive seller.”As its market share in Alberta and B.C. grows, and Ava has more capital to invest, it hopes to be in a better position to explore other opportunities.Advice Asked what advice they have for clinics considering a new EMR, Dr. Forseth urges doctors to have a close look at the contract they’re asked to sign by other vendors because many of them have terms that can be quite restrictive if they are unhappy and want to exit the relationship. He also advises doctors to demo several products and warns them against being tempted by discounts “because you get what you pay for in the end.”“In one instance, we heard that clinics were offered three years for free on a seven-year contract,” added Dr. Henschke. In another case, a clinic that chose a competitor based on price but was unhappy and wanted to switch to Ava was told they had to pay $100,000 to get out of the contract they signed.He also advises doctors against being blindsided by flashy features and to focus instead on the efficiency of “the boring stuff” that accounts for 80 % of their daily workflow.

Into what seemed a mature market, two FPs designed a new EMR—and 230 clinics have signed up

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