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Your digital future awaits

The reality is that an electronic practice environment is becoming the new norm, and every physician must think hard about when to make the move or come up with compelling reasons why not.

Dr. Ruth Collins-Nakai (CMA president 2005-2006) in Future Practice, April 11, 2006

When my predecessor wrote that comment nine years ago, practising in a paper-based environment – and not making use of information technology – to provide patient care was still an option.

That choice is now gone.

For better or worse, Canadian doctors are all eventually going to be practising in a digital environment. Most feel the tools and connectivity provided by electronic medical records (EMRs), digital devices and telemedicine will eventually make them more productive and allow them to provide better care.

The sad news is that while many doctors may not want to continue working in a paper-based environment, they are forced to because EMRs and data-sharing systems are still not readily available (or supported) where they practise. Even those who have EMRs are often still forced to write prescriptions on paper, accept paper faxes or receive consultant reports or referrals on paper.

This reality is underscored by findings of the most recent National Physician Survey (NPS), profiled in this issue. Overall, the survey findings are a good-news story. The number of physicians using EMRs continues to steadily increase. In some provinces and territories almost every family doctor eligible to use an EMR has one.

But there remain significant gaps and inconsistencies. In provinces such as New Brunswick (37.9%) and Quebec (36.5%), more than a third of physicians are still using paper charts exclusively to capture patient information. Even in Alberta, where 39.9% of physicians report using EMRs exclusively to enter or retrieve patient notes, almost half say they still use a combination of paper and electronic charts.

At a time when half of all physicians report using a mobile application in their practice and many, including me, retrieve patient notes on a mobile or tablet device there are physicians who report they can’t even use a computer in their office to enter records because they don’t have access to the appropriate device or system.

Statistics from the NPS point clearly to the need for more to be done at the national level to ensure sufficient resources are made available for Canadian physicians to implement EMR systems.

Much effort must also go into helping physicians as they strive to make the best use of their EMRs to deliver better patient care. The NPS shows many doctors are still just using the EMR as a glorified data-entry tool. We must provide the support to show our colleagues how they can use the systems more effectively. Change management support is also vital, as the journey to integrate an EMR into a practice can be a slow, frustrating one — as even seasoned physician EMR users relate.

Significant work is also needed at the national level to help enforce standards on interoperability so that systems can exchange data effortlessly. Many dollars and much effort have been expended to bring us to the point where

we can even talk about interoperability. We must continue this effort.

It’s all very well to speak about “one patient, one chart” as provinces including Alberta, Prince Edward Island and Nova Scotia are doing. But that road can be long and costly. Time may be better spent making incremental gains to lessen the frustrations facing physicians who must interact with seven different laboratory record systems, or who cannot exchange data with their local community hospital.

What is needed now is good business sense, a collaborative spirit and consistent messaging from all stakeholders. Interoperability is a priority. We hope those who supply EMRs and those in government who can mandate standards are listening.

As Jennifer Zelmer from Canada Health Infoway notes: “At the end of (the) day, when the patient is in front of you, you care about the information, and don’t necessarily care about the back-end platform.”

Dr. Chris Simpson is president of the Canadian Medical Association