Will health care ever go digital?
Canadians want access to electronic health services, but we may not get it any time soon
By Lisa Manfield
February 25, 2011
February 25, 2011
Modern medicine has undoubtedly worked miracles when it comes to prolonging life, curing disease and enhancing quality of life. And, however controversial, progress in medicine can often be attributed to advances in technology. So why is it, then, that when Canadians visit their doctor’s office or local hospital, more often than not they are still faced with paper charts and walls of files? In this digital age, why is our medical system still predicated on paper-based records?
“There are quite a few barriers to the use of electronic medical records by family physicians,” said Dr. Martin Dawes, the chair of family medicine at McGill University. “People are fearful of new systems, and then there’s the cost.”
Nevertheless, it’s clear Canadians are ready for more technology in their personal health care. A 2009 Deloitte survey entitled Treating patients as consumers indicated almost two-thirds of Canadians want access to a personal health record, and 51 per cent want to be able to schedule office visits, view test results, order prescription refills, find out about treatment options and check status payments securely online. And half of the survey respondents also want the ability to communicate with their health care providers by e-mail.
So why can’t they?
Not for lack of technology
It’s not a lack of technology that’s holding back electronic health care systems. There are dozens of vendors in North America vying for server space in medical offices and hospitals across Canada. Their offerings include electronic medical records systems (EMRs), personal health records systems (PHRs), scheduling systems and telehealth systems, among others.
Vendors include big players like Telus Health Solutions, which ranked number one on Branham’s mixed-play health care companies for 2009, and pharmaceutical giant McKesson, which has systems across North America. Even Microsoft and Google have joined the personal health records space, offering applications that enable individuals to aggregate and store their health records online.
But according to David Branson, former product manager at McKesson Medical Imaging Group in Richmond, B.C., the main challenges in giving Canadians access to online health management tools are funding for practitioners and interoperability amongst systems. “Right now the system is very fragmented,” he said, “and it’s hard to set up—physicians still have to do it on their own, and hospitals have already invested in legacy systems which are hard to upgrade.”
Ronald Dunn, McKesson’s vice-president of sales in Canada, added, “Canada is only just beginning to consider that patients are entitled to full access to their medical records. I believe there remains a considerable effort to educate both the public and the providers of this new paradigm.”
Failure to install
While many provinces have government incentives in place for medical practitioners who purchase EMRs from a list of pre-approved vendors, it hasn’t been enough to engender widespread adoption, Dawes said. “I think it’s slow. It hasn’t swept across the country.”
A 2007 National Physician Survey by the Canadian Medical Association (CMA) reported only 12 per cent of family and general physicians use electronic charts, while 19.4 per cent use a combination of paper charts and electronic records.
“It has improved in the last two years,” said CMA president Dr. Anne Doig. “Changes in some of the provinces in the way funding has been negotiated have led to greater uptake.” Doig herself has had an EMR in her Saskatoon clinic for 10 years, and recently upgraded when funding became available. “But we still can’t link in any meaningful way to the outside world,” she said of her new EMR. “I can’t share my information in a secure way with hospitals or patients. We’re still light years away from being able to do the things patients expect us to be able to do.”
A lack of technical skills among medical practitioners is another barrier to adoption, but there’s also the matter of research, purchase and implementation time—which no doctor has en masse.
B.C.-based family physician Dr. Alan Brookstone took it upon himself to facilitate the research process in 2004 when he founded a Canadian EMR Web site to catalogue, review and compare available electronic health management products. The site (http://emruser.typepad.com) has since evolved to become the premier resource on electronic health info in Canada, with 2,500 registered users. “There’s a real need to focus on getting core EMR systems adopted by physicians,” he said. “Thirty to 35 per cent have adopted them, but only 10 to 15 per cent have the capability to share information. And there are big gaps across the country. There is a lot of information that can be made available to patients, but it adds a layer of complexity to the system.”
CBC columnist Steven Strauss, who has been exploring the state of electronic health records in Canada, likened the difficulty of building an integrated electronic health care information management system to that of developing a road system with “superhighways, toll booths, bridges, lane divisions, speed signs, parking meters, trolley tracks, billboards, off ramps, warning lights, no parking between 4 and 6 p.m. signs, handicap parking, bus stops, taxi stands, stop lights with turn signals, and crossing warnings for pedestrians,” not to mention teaching everyone to drive.
It’s not a feat that can be accomplished all at once, and in a health care system that involves multiple layers of service providers, funders and jurisdictions, it’s a task that requires a level of central coordination that is not occurring in Canada.
“Federal plans are limited to First Nations, so the Feds are not really affecting the provinces or any of the large health systems in the provinces,” said McKesson’s Dunn. “Within the provinces, there is variation across the country. Some provinces are collapsing individual health plans or systems under the umbrella of a single provincial management structure while other provinces choose to let health systems operate themselves without any additional oversight.”
And Branson said “there is no central repository and the biggest problem is connectivity.”
But according to Dawes, the larger the system, the less benefit to physicians and patients. He cites the U.K. as an example of the kind of information overload that occurs with a fully interconnected system. “Let’s say a patient goes into intensive care and the system is exchanging information with me. I log in and the patient has had 482 blood tests, which is not an exaggeration. Suddenly my system is filled with lab results and to find what I need I have to wade through them all. Plus, the bigger the system, the more problems there are with speed.”
But Brookstone believes a national system would ultimately “improve patient care and save money” in the long term. “The vision is correct and it may sound like everything is up in the air, but 50 years from now we’ll look back and think ‘how did we operate like that?’”
Physician success
While patients await alignment of medical infrastructure, physicians are at least starting to reap some benefits from digitizing their own records. Dawes is part of a growing group of physicians opting to install an open-source browser-based EMR called OSCAR.
Developed in 2001 at the Department of Family Medicine at McMaster University, OSCAR now has a documented user base of almost 1,000 physicians across Canada, many of whom are wildly enthusiastic about it. Witness Dr. Gunther Klein, a family physician in a group practice in Campbell River, B.C., who switched last year from a “proprietary and expensive system” to OSCAR. “This has been a resounding success in our office,” he said. “Besides the obvious benefit in terms of savings in staff and physician productivity and time, the clinical benefits mainly relate to being able to compile longitudinal patient information more effectively, find historical patient information faster and use effective decision support tools to better inform decisions and improve follow up with your patients.”
Dawes adds that open-source systems are less costly than proprietary systems, and benefit from frequent updates. “The cost is that of a server. The system is easy to use, and I tested it in one of the worst settings—urgent care. It worked extremely well.”
But neither doctor has yet implemented OSCAR’s companion patient access system MyOSCAR. “It’s on our list of to-dos,” Dawes said.
For the records
So when will Canadians gain access to their personal electronic health records and accompanying services? The guesses vary wildly and they’re just that—guesses.
Broosktone believes “50 years is not an unreasonable timeframe, but we will probably achieve a level of competence in sharing info in 30 years.”
Doig, however, is much more optimistic, stating we should be “moving toward better connectivity among health providers in the next three years.”
Meanwhile, Dawes said the system will come eventually, “but it may not come directly from patients wanting electronic records.” Incentive programs have more impact on such changes than consumer wish, he said, but “good systems demonstrated effectively are likely to take off. But I don’t know when.”
Backbone's eHealth blog
“There are quite a few barriers to the use of electronic medical records by family physicians,” said Dr. Martin Dawes, the chair of family medicine at McGill University. “People are fearful of new systems, and then there’s the cost.”
Nevertheless, it’s clear Canadians are ready for more technology in their personal health care. A 2009 Deloitte survey entitled Treating patients as consumers indicated almost two-thirds of Canadians want access to a personal health record, and 51 per cent want to be able to schedule office visits, view test results, order prescription refills, find out about treatment options and check status payments securely online. And half of the survey respondents also want the ability to communicate with their health care providers by e-mail.
So why can’t they?
Not for lack of technology
It’s not a lack of technology that’s holding back electronic health care systems. There are dozens of vendors in North America vying for server space in medical offices and hospitals across Canada. Their offerings include electronic medical records systems (EMRs), personal health records systems (PHRs), scheduling systems and telehealth systems, among others.
Vendors include big players like Telus Health Solutions, which ranked number one on Branham’s mixed-play health care companies for 2009, and pharmaceutical giant McKesson, which has systems across North America. Even Microsoft and Google have joined the personal health records space, offering applications that enable individuals to aggregate and store their health records online.
But according to David Branson, former product manager at McKesson Medical Imaging Group in Richmond, B.C., the main challenges in giving Canadians access to online health management tools are funding for practitioners and interoperability amongst systems. “Right now the system is very fragmented,” he said, “and it’s hard to set up—physicians still have to do it on their own, and hospitals have already invested in legacy systems which are hard to upgrade.”
Ronald Dunn, McKesson’s vice-president of sales in Canada, added, “Canada is only just beginning to consider that patients are entitled to full access to their medical records. I believe there remains a considerable effort to educate both the public and the providers of this new paradigm.”
Failure to install
While many provinces have government incentives in place for medical practitioners who purchase EMRs from a list of pre-approved vendors, it hasn’t been enough to engender widespread adoption, Dawes said. “I think it’s slow. It hasn’t swept across the country.”
A 2007 National Physician Survey by the Canadian Medical Association (CMA) reported only 12 per cent of family and general physicians use electronic charts, while 19.4 per cent use a combination of paper charts and electronic records.
“It has improved in the last two years,” said CMA president Dr. Anne Doig. “Changes in some of the provinces in the way funding has been negotiated have led to greater uptake.” Doig herself has had an EMR in her Saskatoon clinic for 10 years, and recently upgraded when funding became available. “But we still can’t link in any meaningful way to the outside world,” she said of her new EMR. “I can’t share my information in a secure way with hospitals or patients. We’re still light years away from being able to do the things patients expect us to be able to do.”
A lack of technical skills among medical practitioners is another barrier to adoption, but there’s also the matter of research, purchase and implementation time—which no doctor has en masse.
B.C.-based family physician Dr. Alan Brookstone took it upon himself to facilitate the research process in 2004 when he founded a Canadian EMR Web site to catalogue, review and compare available electronic health management products. The site (http://emruser.typepad.com) has since evolved to become the premier resource on electronic health info in Canada, with 2,500 registered users. “There’s a real need to focus on getting core EMR systems adopted by physicians,” he said. “Thirty to 35 per cent have adopted them, but only 10 to 15 per cent have the capability to share information. And there are big gaps across the country. There is a lot of information that can be made available to patients, but it adds a layer of complexity to the system.”
CBC columnist Steven Strauss, who has been exploring the state of electronic health records in Canada, likened the difficulty of building an integrated electronic health care information management system to that of developing a road system with “superhighways, toll booths, bridges, lane divisions, speed signs, parking meters, trolley tracks, billboards, off ramps, warning lights, no parking between 4 and 6 p.m. signs, handicap parking, bus stops, taxi stands, stop lights with turn signals, and crossing warnings for pedestrians,” not to mention teaching everyone to drive.
It’s not a feat that can be accomplished all at once, and in a health care system that involves multiple layers of service providers, funders and jurisdictions, it’s a task that requires a level of central coordination that is not occurring in Canada.
“Federal plans are limited to First Nations, so the Feds are not really affecting the provinces or any of the large health systems in the provinces,” said McKesson’s Dunn. “Within the provinces, there is variation across the country. Some provinces are collapsing individual health plans or systems under the umbrella of a single provincial management structure while other provinces choose to let health systems operate themselves without any additional oversight.”
And Branson said “there is no central repository and the biggest problem is connectivity.”
But according to Dawes, the larger the system, the less benefit to physicians and patients. He cites the U.K. as an example of the kind of information overload that occurs with a fully interconnected system. “Let’s say a patient goes into intensive care and the system is exchanging information with me. I log in and the patient has had 482 blood tests, which is not an exaggeration. Suddenly my system is filled with lab results and to find what I need I have to wade through them all. Plus, the bigger the system, the more problems there are with speed.”
But Brookstone believes a national system would ultimately “improve patient care and save money” in the long term. “The vision is correct and it may sound like everything is up in the air, but 50 years from now we’ll look back and think ‘how did we operate like that?’”
Physician success
While patients await alignment of medical infrastructure, physicians are at least starting to reap some benefits from digitizing their own records. Dawes is part of a growing group of physicians opting to install an open-source browser-based EMR called OSCAR.
Developed in 2001 at the Department of Family Medicine at McMaster University, OSCAR now has a documented user base of almost 1,000 physicians across Canada, many of whom are wildly enthusiastic about it. Witness Dr. Gunther Klein, a family physician in a group practice in Campbell River, B.C., who switched last year from a “proprietary and expensive system” to OSCAR. “This has been a resounding success in our office,” he said. “Besides the obvious benefit in terms of savings in staff and physician productivity and time, the clinical benefits mainly relate to being able to compile longitudinal patient information more effectively, find historical patient information faster and use effective decision support tools to better inform decisions and improve follow up with your patients.”
Dawes adds that open-source systems are less costly than proprietary systems, and benefit from frequent updates. “The cost is that of a server. The system is easy to use, and I tested it in one of the worst settings—urgent care. It worked extremely well.”
But neither doctor has yet implemented OSCAR’s companion patient access system MyOSCAR. “It’s on our list of to-dos,” Dawes said.
For the records
So when will Canadians gain access to their personal electronic health records and accompanying services? The guesses vary wildly and they’re just that—guesses.
Broosktone believes “50 years is not an unreasonable timeframe, but we will probably achieve a level of competence in sharing info in 30 years.”
Doig, however, is much more optimistic, stating we should be “moving toward better connectivity among health providers in the next three years.”
Meanwhile, Dawes said the system will come eventually, “but it may not come directly from patients wanting electronic records.” Incentive programs have more impact on such changes than consumer wish, he said, but “good systems demonstrated effectively are likely to take off. But I don’t know when.”
Backbone's eHealth blog
