Canada and US in Race to be Slowest Adopter of EMRs in Developed World
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:
- 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;
- 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;
- 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;
- Facilitate electronic prescribing by streamlining the prescribing capabilities of EMR systems and allow prescriptions to flow electronically between physicians and pharmacists;
- 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
'Hello Health' (Facebook meets Housecall). Is this the Model for Primary Care in the Future?
Primary care is going through a painful transition. The old system of fixed bookings, long hours, long waits in the physician's office and limited access are being challenged by new models of care. One group that is thinking outside of the box is 'Hello Health'. The group will be launching their first 'Node' in New York city shortly. Even the term 'Node' conjures up something a little mystical from the realm of an IT think-tank or perhaps a disseminated malignancy. I am sure the word was well thought out before it was used. The company believes that healthcare delivery is inefficient (true) and costly (true - in the US in particular) and is seeking to provide mobile technology enabled physicians who will provide consultations via tele-health or instant messanging or e-mail. New York is also a good choice for the launch of this model. High density, large numbers of potential patients and good public transportation. The model is a novel approach to a complex problem. It will not solve all of the issues related to access, but these physicians and their team are pioneers and I think that the model deserves further investigation by more traditional providers of care.
Some time back, I posted a story on Dr. Jay Parkinson, who is now the chief medical officer for Myca, the company that has developed an EMR system and platform to support this model of care. The company is Canadian and based out of Quebec City and intends to offer real-time video conferencing between physicians and patients when it launches.
Complex disease such as cancer may not be ideally suited for this type of care delivery, however in a world of connected devices, home monitoring and ubiquitous internet access delivery of care using these types of tools should not be impossible. However it does require a change in mind-set and a different approach.
As we build new healthcare models including Open Access and Shared Care, could we be simultaneously implementing new tools and processes?
I am not sure how this all fits together in an integrated model of care. The objective should not be a handful of physicians who are seen by their colleagues to be on the fringe of healthcare delivery, but a well defined model and value proposition that allows the large majority of physicians to adjust their practice styles and realistically incorporate advanced technologies to provide high quality and efficient care.
Do you agree with this type of approach to care delivery? Could you see it as an extension of your current practice? If you had to start again, with today's technologies would you emulate Dr. Jay Parkinson?
Alan Brookstone
Canadian EMR
Are GP Oriented EMRs Appropriate for Specialists?
This is the first posting in a new section that I have created on CanadianEMR focused specifically on specialist needs for EMR. The focus in Canada to date has been to identify EMR systems that meet the needs of GPs, the largest single group of physicians. This has also occurred at a time that primary care has begun a significant transition process. Ontario has limited funding for EMRs to primary care physicians who are willing to change their practice structure to a shared model of care through FHTs, FHNs, FHGs. Alberta recognized the needs of specialists and through their funding program, provided support for specialists to adopt EMR systems. British Columbia, through the PITO program has also designated funding for both specialists and GPs, however with different limitations to Alberta.
Requirements for EMRs as a result of RFPs, selection and conformance testing processes across Canada have tended to select out EMR systems that are designed to meet the needs of GPs rather than specialists. However, is this statement really true? Can these systems be used efectively by specialists? Are there differences between specialties that require specific EMR solutions in order to meet these needs? Are there some basic requirements for all EMR systems that should be able to meet the needs of GPs and specialists equally? The purpose of this posting is to begin to flush out these thoughts and ideas.
Canada is at a critical juncture as we begin to deploy EMR systems more widely. 50% of physicians in Canada are specialists and the critical business need in a functional health care system is for GPs and speciliasts to be able to communicate effectively with one another (as occurs in the paper world). Your thoughts, comments and feedback will help to inform this critical issue.
Alan Brookstone
Canadian EMR
A Special Report from Canada Health Infoway - Electronic Health Records for Canadians
Read a special report released by Canada Health Infoway discussing Electronic Health Records for Canadians:
Doctor's offices and patients see benefits
When a drug is recalled, informing patients quickly is vital.
Technology overcomes geography
For the many Canadians who live outside of the major urban centres, accessing critical health care often involves the emotional and financial trauma of leaving family and home behind...
Better management, accountability improves access for patients
Grace De Jong's breast cancer was successfully treated by lumpectomy in 1999, but recently she began experiencing new symptoms.
Link: A Special Report from Canada Health Infoway - Elecronic Health Records for Canadians.
Alan Brookstone
Canadian EMR
PITO Web Site Launched in British Columbia
The British Columbia PITO (Physician Information Technology Office) web site has just launched providing information about the PITO program, EMR funding, Connectivity and Physician engagement.
Electronic Medical Records - EMRs are one of seven essential elements of British Columbia’s long term vision for the integration of information and communications into the health care system as outlined in the province’s e-Health Strategic Framework of November 2005. The other six components are: the Interoperable Electronic Health Record (iEHR), the Provincial Laboratory Information Solution Project (PLIS), the eDrug Project (PharmaNet II), the Provincial Diagnostic Imaging Project (Connecting DI), the Public Health Information Project (PHIP), and Telehealth.
PITO is distinguished from the other e-Health initiatives in its focus on implementation of technology in physicians’ offices – a vital link in e-Health since that’s where most patient information is captured and most patient care is delivered. PITO is governed by a Steering Committee of three practicing physicians appointed by the BCMA and three representatives appointed by the provincial government, and acts on a consensus basis. It reports to the e-Health Steering Committee, which in turn reports to the BC Health Leadership Council, comprised of CEOs from BC health authorities and senior executives from the MOH. PITO in BC is preceded in Alberta and Ontario by the Physician Office System Project (POSP) and OntarioMD. Lessons learned by these two organizations have been shared and incorporated into the PITO program and processes. PITO is also working in collaboration with the BC Practice Support Program (PSP).
Click here to visit the PITO web site
Alan Brookstone
Canadian EMR Blog
Infoway - Canadians' support for electronic health records increases to 88 per cent, poll finds
A survey conducted by EKOS Research Associates including interviews with 2,469 Canadians in June and July 2007 and published today by Canada Health Infoway has found that there is increasing support for EMRs/EHRs, however there is significant concern regarding privacy and the need to protect sensitive information. A striking finding (to me) is the desire by 55% of Canadians to want to mask or hide certain information in their Electronic Health Record. Given this number, developers of EMR systems and policy/legislative bodies will need to ensure that masking capability exists within large EHR systems or they will risk the Canadian public losing confidence in the system.
"It is clear Canadians want the protection of their privacy to be a key factor as we consider both how these highly sensitive records are managed, as well as potential secondary uses for this information including health research," said Jennifer Stoddart, Privacy Commissioner of Canada.
- Canadians want to ensure that privacy and security safeguards are in place to protect their health information. 77 per cent would like audit trails that document access to their health information. 74 per cent want strong penalties for unauthorized access.
- 66 per cent of Canadians want clear privacy policies to protect their health information.
- In the event of a security breach, 7 in 10 want to be informed and would like procedures in place to respond to such breaches.
- Those who have had experience with an electronic health record showed an even stronger support for privacy and security safeguards.
- A majority of Canadians (55 per cent) would like to be able to hide or mask sensitive information contained in their record.
- While the poll shows strong support (84 per cent) for using anonymous information from electronic records for health research, this support drops dramatically if personal details are not removed from the record (50 per cent)
To read the full article, go to: Infoway - Canadians' support for electronic health records increases to 88 per cent, poll finds.
Alan Brookstone
Canadian EMR Blog
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