A lot of information is shared during a patient’s care journey — between physicians and with other health providers, government agencies, insurance companies and patients themselves. From sick notes to tax credit forms, prior authorization for therapies to insurance claims, the paper pile-up for doctors can feel endless.
But it’s not just paperwork. Fast, accurate and secure sharing of health information is crucial for choosing the right, safe treatments and giving patients the best care possible.
This is where electronic medical records (EMRs) were supposed to help. While some form of electronic health record-keeping was available as early as the mid-1960s to 1970s, EMR technology became widespread in Canada in the 2000s, promising greater efficiency, improved portability and reduced physician administrative burden.
Twenty years later, EMR adoption and advancement vary greatly across the country. For many providers, the cost of implementing an EMR or a lack of access to reliable Internet service serve as significant barriers to entry. A lack of interoperability between systems also means health information does not travel well between providers, let alone provinces and territories.
It’s no surprise then that in 2022, a national survey from the Canadian Institute for Health Information showed fewer than 40% of Canadians outside of Quebec have accessed their health information online. It’s not for lack of desire. The same survey found 80% of respondents would like to access their health information electronically.
Canada has a long way to go in accessibility of health information for doctors, too. A Commonwealth Fund survey from 2022 showed that only 38% of primary care physicians in Canada can share patient information with other doctors electronically — compared to a 67% average in other developed countries.
These barriers often leave doctors caught between electronic systems that don’t talk to each other and their patients’ growing needs. “As a family physician, I see first-hand the impact administrative burden can have on a medical practice,” says David Metcalfe, a family physician and Newfoundland and Labrador Medical Association (NLMA) board member.
One pain point is the ongoing burden of actual paper forms on top of EMRs. With support from the Health Care Unburdened Grant program, NLMA is integrating provincial drug program authorization request forms, currently a paper-based process required for patients to access certain therapies, with its provincial electronic medical record.
“We came together on this proposal… following a survey that the NLMA did of its members and NLP forms [were] one of the highest ranked administrative burdens by physicians,” says Lucy McDonald, digital health senior advisor for the NLMA.
In some jurisdictions, physicians themselves continue to rely on paper records. The New Brunswick Medical Society (NBMS) is using a Healthcare Unburdened Grant to increase and optimize the use of EMRs in the province by providing practice support teams and training clinical champions.
“We anticipate that having more physicians switch from paper to electronic records, as well as providing ongoing support to help those using EMRs do so more optimally and efficiently, will result in significantly less time spent on administrative tasks and a more streamlined charting process,” says René Boudreau, NBMS CEO.
Leveraging existing electronic systems to find efficiencies and improve processes can also help reduce administrative burden on physicians.
Grant recipient GreenShield, for example, is launching the first electronic prior-authorization standard for medication and therapy in Canada. It will roll out nationwide with a focus on rheumatology, with a longer-term goal of scaling to all conditions.
“This innovative technology will usher in a new standard for prior authorization in Canada and significantly reduce that burden, allowing doctors to dedicate more time to patients,” said Ramy El-Kholi, Chief Commercial Officer of OkRx, a Canadian tech company focused on connecting health care communities through technology solutions.
Doctors Manitoba, meanwhile, is using funding to simplify medical certifications doctors are frequently asked to provide. “Sick notes and other common third-party requests are a major burden for physicians, and we have to find a better way,” says Dr. Candace Bradshaw, a Winnipeg family physician and former president of Doctors Manitoba.
There is broader progress on a digital-age health system as well. In June, the federal government introduced health data legislation to mandate common standards for health information and improve access. Together with innovations at the provincial/territorial level that have potential to scale up, technology might finally bring us closer to a more effective and efficient health system — one where digital tools like EMRs serve patients and providers instead of the other way around.
The Health Care Unburdened Grant program is part of the Canadian Medical Association,
MD Financial Management Inc. and Scotiabank’s long-standing, joint commitment to supporting physicians and the communities they serve across Canada.
CMA is working in collaboration with Healthcare Excellence Canada (HEC) to support selected teams through coaching, focused learning activities, networking and knowledge-sharing.