January 12, 2012 5:45 AM

It is more than one year since the US HITECH Act was announced, which defined the Meaningful Use incentive program to encourage adoption of EMRs by eligible providers including physicians and nurse practitioners. (Note: The terms EMR and EHR are used interchangeably in the U.S., although in Canada they applied specifically to physician systems vs. regional provincial electronic record systems.) So, what has happened in both countries over the past 18 months and how do the national programs compare against one another?

As founder of both CanadianEMR.ca and AmericanEHR Partners (www.americanehr.com), I have had an opportunity to observe both markets from the perspective of clinical users, product performance, and the industry. CanadianEMR and AmericanEHR Partners have 3,450 and 11,400 users respectively, of which the majority are physicians (69% in the US and 58% in Canada).

The 2009 Commonwealth Fund International Health Policy Survey reported 37% of physicians in Canada using EMRs and 46% in the U.S. As the Commonwealth data is now two years old, it is safe to assume that adoption levels of EMR systems have increased over the past two years, although growth is difficult to accurately quantify. More important is determining the effective use of these adopted EMR systems — technology for the sake of technology does not translate into improvements in care.

Effective use is significantly lower than adoption levels and is the metric that should be more comprehensively measured. For example, the 2010 Canadian National Physician Survey reported a total of 16.1% of physicians using Electronic Medical Records instead of paper charts. This compares to 9.8% in 2007 (21.5% of GPs and 10.1% of specialists in 2010 vs. 12.3% and 7% respectively in 2007). If one applies increasingly more scrutiny to these data, with approximately 37% of physicians using EMRs in 2009 (Commonwealth Fund) and 16.1% of physicians reporting use of EMRs instead of paper charts (NPS 2010), it is reasonable to assume that an even smaller percentage are using their EMRs effectively. Similarly in the U.S., the 2009 National Ambulatory Medical Care Survey (NAMCS) indicated that just 6.3% of physicians were using fully functional EMRs although 43.9% of physicians reported using any EMR system.

The bottom line is that a very small number of clinicians are effectively using EMR systems. There is much room for improvement.

Canada

The past two years have been a difficult time for health IT and EMRs in Canada. All of the provincial programs have seen growth in EMR adoption, but the pace has slowed. Although there is variation from province to province, adoption levels are stalled around the 50% mark. It is my belief that a lack of national leadership, combined with ineffective policy, is keyholing Canada into many small unsustainable EMR markets. As healthcare comes under further pressure through provincial negotiations between governments and medical associations, the long-term sustainability of EMR programs is being brought into question, creating a need for more wide reaching policy that encourages adoption and effective use by the remaining 50% of clinicians who have yet to adopt.

My overall score: 2/5

• Areas for improvement include messaging standards, transmission of referrals and consultations, chart transfer between EMR systems, electronic prescribing, and medication management.
  
  

United States

The announcement of the HITECH Act and the Meaningful Use program put the U.S. EMR market into hyperdrive. Vendors worked feverishly on enhancements to their EMR systems in order to achieve national certification as ONC-ATCB certified products. Over 400 EMR systems have now achieved ONC-ATCB Stage 1 certification; however, the ambulatory market is dominated in the U.S. by a small number of vendors and products. According to an October 2011 AmericanEHR Partners Survey, 68% of 1,936 survey responses represented 10 EMR products. As of September 2011, incentive payments for the Meaningful Use of EMRs (under the Stage 1 criteria) totalled $80,375,006. This is a smaller than anticipated number, but payments and declaration under these criteria are accelerating. The primary difference between EMR adoption in the U.S. vs. Canada at this time is vendor capacity to deliver. One popular EMR vendor has a waitlist of 18 months to implement their software. This scenario is playing itself out with a number of other EMRs. There is simply too much demand. 

My overall score: 3.5/5

• Areas for improvement include improvements in usability of EMR products, increasing capacity and ability to deliver solutions, and coordination of policy relating to E-prescribing and Meaningful Use.

Blogger Profile: Alan Brookstone
CanadianEMR is an authoritative and widely recognized national resource for physicians, medical office staff, healthcare planners, government organizations, and vendors of EMR systems.

Posted by Sue Ansell at January 12, 2012 5:45 AM

Categories: eHealth

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