I don't know about you, but I am getting tired of reading articles in journals and in the media that point to Canada being the slowest to adopt EMRs in the developed world! The recent article in the NEJM (see below) points out just how rotten we are and in a race with the US for worst track record. Despite my unhappiness, I am not disputing the data, I think that it is quite accurate and that it is an embarrassment.

What I would like to see is a better understanding of our current state. Simply stating that clinicians are technophobes is not only inaccurate, it simplifies a very complex situation and does not provide any concrete solutions.

I have spent a great deal of time and energy looking at the physician adoption of technology over the past 10 years, trying to understand the barriers and to identify where we should be focusing our energy.

Here is my Top 5 list of areas to focus on that will support adoption and use of EMRs by physicians:

1. Focus on matching technology to the work patterns of physicians and their staff. We have not done enough to understand the needs of GP/FPs and Specialists and the importance of ensuring the EMR systems allow GPs to send referral letters to specialists and that consultation letters flow electronically from specialist to GP;
2. Ensure that funding programs to support uptake and use of EMR systems by physicians are inclusive of GPs and Specialists. Funding purely focused on primary care adoption of EMR will not help us solve the issue that I have identified in my first point above;
3. At the very minimum, ensure that specific data is able to flow between different EMR systems according to messaging standards such as those adopted in Denmark and New Zealand. This will enable the transfer of referral and consultation letters between systems in addition to other critical data;
4. Facilitate electronic prescribing by streamlining the prescribing capabilities of EMR systems and allow prescriptions to flow electronically between physicians and pharmacists;
5. Support the development of medical device standards for monitoring and diagnostic devices. This will ensure that a level of plug-and-play capability is reached so that it is possible to use any device with any EMR or EHR. In the same way that we can currently plug in a mouse or a printer, this capability should exist so that we allow physicians to select the EMR system that meets their needs and then choose their devices rather than choose an EMR based on compatibility with a device.

Read the Ottawa Citizen article:

"The Ottawa Citizen - Tuesday June 28, 2008: Canada is in a tight race with the United States for an unwanted title: slowest adopter of electronic medical records in the developed world. Only one in five, or 20 per cent, of American doctors uses electronic medical records, the New England Journal of Medical reported this month, and less than nine per cent of practices with three or fewer doctors use them. In Canada, according to the 2007 National Physician Survey, fewer than 10 per cent of doctors have switched entirely from paper to electronic records, though about a quarter use some combination of the two. The stubborn attachment to old fashioned filing cabinets is unfortunate. Digitizing medical records reduces medical errors, improves preventative care and saves administration costs, and Canada is so far behind most other countries in this area that it's embarrassing.

"The benefits to patients and workers, however, are too great to ignore. In this sense, the situation is analogous to that facing other industries, which deal not with patients but with customers. Adapting to technologies requires an outlay of money and resources, but without these investments it will be impossible to remain productive. Organizations plagued by inertia and technophobia will suffer, and that includes public sector health care organizations. To their credit, the federal and provincial governments have invested more in health-care information technology than has the U.S., but that is a meagre accomplishment. We should strive to be better than second worst."

Read the full article: Unhealthy technophobia