Ontario Leading the Way with EMRs? Really?

According to an article posted on the CTV Toronto website, Health Minister Deb Matthews is quoted as saying:

“We’ve got more physicians with electronic medical records than any other province in the country. We are now a leader when it comes to the adoption of it.”

Hang on just a sec, Minister Matthews.  I am huge proponent of the value of EMRs in physician offices and I think that there is a critical role for eHealth Ontario to play in driving use of IT in healthcare.  HOWEVER … I think that it is disingenuous to say that Ontario is a leader just because nearly 5,500 doctors have installed an EMR.

To start, according to Canadian Medical Association statistics, only three provinces (QC, QB, and BC) have more than 5,500 doctors and only one province (QC) has more than 5,500 family physicians (the type of physician typically targeted for an EMR).  So, the claim that Ontario has more doctors that have adopted an EMR than any other province is a rather hallow victory.  What would be more useful is a comparison expressed in terms of a percentage of the doctors in each province.   I highly suspect when viewed in this light that Ontario is not the leading province in terms of EMR adoption.

Another important distinction is “adoption” vs “use”.  Just because a physician has installed an EMR doesn’t mean that they are making “meaningful use”.  A 2009 Commonwealth Fund study showed that both Canada and the US lagged most other industrialized countries in using many of the EMR functions that offer significant clinical benefits.  It would be interesting to know the extent to which the 5,500 doctors who have an installed an EMR are making “meaningful use” of this technology.

As I said earlier in this blog post, I think that Ontario is on the right track with its program to drive EMR adoption and use.  Further, I believe that OntarioMD, the group set up within the Ontario Medical Association to implement Ontario’s EMR program, is making good progress and has many good initiatives in place.  I just don’t believe that we should ignore or gloss over the facts in pursuit of a good news story.



2 responses to “Ontario Leading the Way with EMRs? Really?

  1. Michael Paduch

    Mike, I won’t comment on what the health politician is trying to spin here, there is no value in doing so and you’ve covered the main points well anyway.

    I am not that certain about the notion that Ontario is on the right track. The decentralization of healthcare has served some delivery needs well (such as lead to a better understanding of specific healthcare needs of the population, something Toronto could not do well on its own province-wide) but has done a major disservice in the area of IT.

    It almost seems like the Ministry is not understanding the simple fact that the trend most governments have pursued is actually the reversal of what that Ministry have done: you cannot implement a major IT program if you allow for balkanization of delivery and leave it almost up to every clinic and every hospital to come up with a solution.

    As for the licenses purchased for the EMRs versus the actual, meaningful software use, you are correct: doctors routinely refuse to use the systems approved by eHealth Ontario because many have not been designed for the doctors but for their admins, who remain loyal to the vendors and extend annual maintenance contracts without hesitation. And they also refuse to pay for the systems out of their pocket if they don`t feel these tools are right for them.

    Those family physicians who use the EMRs to a full extent, such as many of those at Appletree Medical Group in Ottawa, use the software that has been designed with a Canadian point-of-care reality in mind: delivery on a mobile device, integration between the registration desk, the doctor, the nurse and the records workflow, no keyboard in the examination room and – well – the whole thing designed to actually cut the time and save money.

    Then it starts making sense and doctors can no longer resist the move to the platform…

  2. I live in a small-town in the Muskoka region. I go to a walk- in and appointment clinic. My doctor is by appointment-only. As soon as a patient reaches the Registration desk, in the immediate background are about four walls of the three doctor’s files, all…..paper. From what I’ve read, it did cost approximately $25,000 to set up an EMR system.
    I have a family relative, she lives in Mississauga and she says even the doctor’s offices she goes to, STILL maintain paper files.
    There would be a MUCH greater flow of patient information between patient/doctor/medical administrator/specialist and/or hospital WITH the EMR system. Yes, my clinic has a fax machine but everything takes SOOO much time.
    I’m sure a computer programmed for the EMR system, would take less time to use than phoning and perhaps having to leave a voice-mail message for a doctor/specialist.
    I’ve spoken to the Nurse, an R.N. I believe who has worked at most of the hospitals in Toronto as an ERN, and possibly even my own doctor. She has a wall computer but the keyboard is kept in her office drawer.
    I almost wish it was MANDATORY for doctor’s offices or walk-in clinics, to got the EMP.

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