More than a third of Canadian physicians still without EMRs

Dr. Jennifer Zelmer, Executive VP at Canada Health Infoway, speaking January 23 in Toronto.

When a drug recall takes place, does your family doctor have the ability to identify which patients are on that drug and notify them in a timely manner?

For more than a third of Canadian doctors that may be very difficult.

Canadian doctors have been slow to adopt electronic medical records (EMRs) and even slower to interact with patients in a virtual environment. Very few Canadians can simply e-mail their doctor or book an appointment on-line.

Speaking at Longwood’s Breakfast with the Chiefs forum this morning, Dr. Jennifer Zelmer, executive vice-president with Canada Health Infoway, points out that if patients were able to renew their prescriptions on-line, view their own test results, and consult virtually with physicians when they wanted, it would lead to 47 million fewer in-person visits and require us to take 18.8 million hours less off work to show up in the doctor’s office.

At present only 64 per cent of Canadian physicians are reporting EMR use – albeit that is up from 16 per cent in 2004. That means it’s taken nearly a decade to persuade an additional 48 per cent of physicians to get on board. Do we really have the patience to wait another decade for the rest to follow?

Canada Infoway CEO Richard Alvarez says that drawing a diagram that shows a range of health practitioners revolving around a patient is a lot easier to do that actually pulling it off in reality. To make that happen we need a common electronic health record.

If you are tired of repeating your case history, tired of showing up for care to find out your latest test results are still sitting with another health care provider – as 17 per cent of Canadians reported in a recent Commonwealth Fund International Policy Survey – or tired of having a schlep across town simply to get a basic prescription renewed, then we should be getting far more aggressive about advocating for change.

One of the problems of sending your doctor an e-mail is there is no way to compensate them for the time it takes to send you a reply. Some provinces have begun to work on this in their physician agreement. It should be a no-brainer.

Doctors have also been reluctant to open their files to patients even though it is every person’s right with very few exemptions.

Zelmer says in a study where doctors’ notes were made accessible to patients the results included an improved adherence to the plan of care. Despite the anxiety doctors felt, no physicians in the study decided to turn off access after the trials.

In an age where doctor’s notes become important for other practitioners and to patients, there is an increased expectation that the notes would be clear to others. One doctor in the audience pointed out that in his notes SOB means shortness-of-breath – an acronym that patients could potentially take the wrong way.

Patient access to their personal test results and medical record also has the potential to create anxiety in an era where health literacy remains low.

It seems odd to talk about the shift to digital medical records when electronic banking has been in use since the 1980s and the first commercial ATM was unveiled in 1972.

The two executives from Canada Health Infoway say that while we are getting closer in our efforts to catch-up with much of the rest of the developed world’s electronic health systems, there are still issues to work through, including getting Canadians ready for these changes.

Part of getting Canadians ready will be to remind them an e-mail is a really bad idea in an emergency situation. Doctors will not be sitting at their terminals waiting for your e-mail to arrive. Despite the opportunity for misuse, they say there has been no evidence of harm in such virtual encounters.

Alvarez says that Canada has primarily used carrots and very little stick to get physicians on board. Ultimately any system is going to have to involve participation of health providers in the final design.

Alvarez says that one of the difficulties of adapting to this new system is that the work can be inefficient if a doctor has to toggle between systems to access information. The key to success will be to bring this information seamlessly into the physicians workflow.

Canada Health Infoway uses federal funding to jointly invest with the provinces and territories “to implement the health information systems needed to manage Canadians’ health and health care information.”

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