The 2010 National Physician Survey (NPS) offers some hard data on adoption and use of electronic medical records by Canadian physicians. In response to a question regarding “Thinking about your MAIN patient care setting, which of these describes your record keeping system?”, respondents indicated that:
- 16.1% use electronic records
- 34.1% use combination of paper and electronic charts
- 37.6% use paper charts only
- 12.2% either did not respond or indicated that the question was not applicable to them
So, it would appear that slightly more than 50% of Canadian physicians use some form of electronic chart. Interestingly, of these physicians, roughly two thirds still use a mix of electronic and paper charts.
The NPS does not provide detailed data on use of EMRs in physician offices. The closest statistic in this regard is the answer to the question “In which setting do you use electronic records most often”, Respondents indicated:
- 43.1% in “Office/community clinic/community health centre”
- 38.8% in “Hospital/AHSC/Emergency Department”
- 1.5% in “University/faculty of medicine/research unit”
- 0.4% in “Nursing home/home for aged”
- 1.5% in “Other” settings
- 0.9% felt that the question was not applicable
- 13.8% did not respond
The CMA’s recently released 5-year Health IT strategy (see my blog post for more details) advocates, among other things, more local and regional integration projects to facilitate the exchange of patient information among providers within local referral areas. A good example of regional integration was recently highlighted in an article in the Hamilton Spectator. According to the Spectator article:
“All electronic hospital records within the Local Health Integration Network can be accessed interhospital, except for Brant Community Healthcare and Grimsby’s West Lincoln. The accessible records for approved persons include hospital visits, treatments and procedures, tests and hospital lab results according to HHS [Hamilton Health Science] officials. Access to individual doctors’ records will come in an unspecified future phase.”
The article offers several quotes from eHealth Ontario’s CEO Greg Reed, including one of the first succinct statements on the role of eHealth Ontario. According to Mr. Reed, “EHealth’s role is to develop common standards to make them connected, and to form central registries of such information as inoculations given.”
Mr. Reed also notes that “Ontario’s Local Health Integration Networks are grouped into five regional areas with their own electronic patient record-sharing system” He suggests that people think of eHealth as a “network of networks” and observes that “The job is not to build electronic records but to expand and connect existing ones – so a family doctor for example, can view radiology and lab results to become better informed about their patients.”
The Canadian Medical Association (CMA) today unveiled their new five-year strategy for HIT investment in Canada. This strategy is a key component of the CMA’s Health Care Transformation Change That Works, Care That Lasts initiative launched in August.
The CMA HIT strategy advocates for more spending on health IT at the point of care. The strategy document points out that:
“To date, major HIT investments have not had much impact on the delivery of care in Canada, mainly because the current investment strategies do not mirror how care is provided. The top-down approach taken thus far focuses the majority of investment on large-scale HIT systems and architecture, with only a small portion targeted to supporting frontline points of care.”
As shown in the figure below, CMA’s strategy is based on three key pillars: Significant Adoption, Effective Use, and Accelerated Exchange of Health Information, which, together, will drive specific and measurable objectives.
Framework for activity (HIT investments)
I encourage you to read the CMA 5-Year HIT Strategy. It reflects the considered thinking of an important stakeholder group, one that for many years was accused of resisting HIT adoption. The CMA’s 5-Year HIT Strategy demonstrates a clear understanding of the benefits that HIT has to offer and suggests a path towards quicker returns on HIT investments.
Earlier this year I was invited to participate in a “think tank” session hosted by the Information Technology Association of Canada (ITAC) and the Canadian Medical Association (CMA) that explored the role of Information and Communications Technology in the Canadian health system. Although I have wanted to blog about this event ever since it ended, I have held off until an official communique on the key findings from the event was officially published.
Earlier this week ITAC issued a summary of key findings from the think tank along with a press release supporting the “digization of our healthcare system”. The think tank, held April 13 and 14 at the Kingbridge Centre north of Toronto, explored “Enabling Transformation of the Healthcare System Through Strategic ICT Deployment Over the Next Five Years” with a focus on three core questions:
- Where is Healthcare and eHealth today?
- Where do we want Health and eHealth to be in five years?
- How are we going to get Healthcare and eHealth there?
An interesting theme that emerged from discussion regarding the future state of the Canadian health system was greater involvement of patients in their health and wellness. Several thoughts reflecting this theme mentioned in the final report include:
- More patient-centric with focus on patient needs and the patient experience
- More self-serve so patients can more proactively participate, such as booking appointments
- More collaborative, allowing for more digital communications between clients and healthcare resources and between practitioners
Another common theme emerging from think tank discussions was the desire to have our eHealth investments “more nationally standard-based so we can more cost effectively realize benefits from future ICT investments” and a recommendation that “We need to place greater emphasis on the use of common standards, making the market more cost-effective for vendors and creating a culture of innovation”. This theme was highlighted in ITAC’s accompanying media release which concludes:
“One thing that is clear is that while provinces and territories are responsible for healthcare delivery, technology cuts across geographic boundaries. So we must think globally as we act locally. As we get closer to the point of care we need to embrace the use of national and international standards, which are the best guarantee of cost-effective and lasting technological solutions. For example, the market for Electronic Medical Record (EMR) systems in doctors’ offices in Canada is a patchwork of differentiated standards and products, which poses a significant barrier to cost-effectiveness, quality and adoption. This requires a concerted effort by Canadian authorities in all jurisdictions to move to the adoption of international and national standards.”
The final report concludes that “digitization of our healthcare system is both pressing and essential to tackle the major challenges of cost increases outstripping growth government revenues or in GDP at an accelerating rate as our population ages”.
I encourage people to read the think tank final report. I’d be very interested to get your reaction and feedback. The document is three pages in length and takes no more than 10 to 15 minutes to read.
At the 2010 Canadian Medical Association General Council, the delegates passed the following resolution:
“The CMA will work with provincial / territorial medical associations to ensure investments made by Canada Health Infoway are aligned with and respect e-health strategies that are currently being implemented or developed within various jurisdictions.”
In the debate surrounding this resolution, one delegate stated that Infoway’s plan to directly fund vendors to meet interoperability standards is “counterproductive”. Another delegate commented that some eHealth agencies takes the position that “It is our way or no way” and noted that Infoway can play an important role in advancing local initiatives.
For the past few months I have been spending considerable time researching the issues and concerns of physicians and patients. As I read Rosie Lombardi’s insightful article in the most recent edition Technology for Doctors, I was struck by the similarity between what physicians and patients both want … better access to personal health information. In particular, Dr. Anne Doig’s comments in Rosie’s article was particularly poignant:
“Many doctors who implemented EMRs said, ‘We wish we could connect properly to other medical entities but we can’t – but we’ll implement electronic records to serve our needs internally.’ So all those EMRs are functioning in isolation from each other.”
Although their reasons may differ, both physicians and patients seem to have a similar rallying cry – “Give me the damn data!” The common denominator in both cases is the role that IT can play in making the data they need to deliver care and manage their health.
In advance of its upcoming annual General Council in Niagara Falls next week, the Canadian Medical Association (CMA) has released a report entitled “Health Care Transformation in Canada: Change that Works, Care that Lasts”. This report describes the CMA’s roadmap for transforming the Canadian health system in order to “improve the health of the population at large, to improve the health care experiences of patients, and to improve the value for money spent on health and health care”.
In its report, the CMA describes a “Framework for Transformation” organized around five pillars:
- Building a culture of patient-centred care
- Incentives for enhancing access and improving quality of care
- Enhancing patient access along the continuum of care
- Helping providers help patients
- Building accountability / responsibility at all levels.
Under the “Helping providers help patients pillar”, the CMA has identified two strategic imperatives:
- Ensuring Canada has an adequate supply of health human resources
- More effective adoption of health information technologies
The CMA contends that “Multi-billion dollar investments made in Canada on HIT, however, have not resulted in significant benefits to providers or patients … due to the fact that all jurisdictions have taken a top-down approach to their HIT strategies”. The CMA points out that IT investments at the points of care “where the actual benefits of HIT will be realized” have been quite low and argues that “we need to move from a top-down approach to one that gives all providers, in particular physicians, the lead role in determining how best to use HIT to improve care, improve safety, improve access and help alleviate our growing health human issue”.
My colleague Rosie Lombardie, editor of Technology for Doctors magazine, recently wrote an excellent article on the CMA’s proposed HIT strategy. This article includes numerous quotes from Dr. Anne Doig, CMA’s President. Dr. Doig pulls no punches in her assessment of how HIT funding has been spent to date and how it should be spent in the future. For example, Dr. Doing states, “The focus has been on building systems for electronic health records (EHR) instead of electronic medical records (EMR)”. She further asserts that “If they had started at the ground level, we would have had 99 percent of doctors on EMRs by now. We would have pushed local health authorities to respond to our demand for downloadable lab results and other practicalities.”
I encourage you to read Rosie’s article. As a practicing physician with practical experience using an EMR, Dr. Doig offers a front line perspective on HIT investments. Rosie has done a great job capturing and presenting Dr. Doig’s views.
At its annual House of Delegates (HOD) meeting last week, the American Medical Association (AMA) amended its current policy regarding Personal Health Records to address concerns about the use of patient supplied data in a PHR:
- “If the patient is allowed to make annotations to his or her EMR …. the annotation should be indicated as authored by the patient with sourcing information …. A permanent record of all allowed annotations and communications relevant to the ongoing medical care of the patient should be maintained as part of the patient’s record.”
- “Physicians retain the right to determine which information they do and/or do not import from a PHR into their EHR/EMR and to set parameters based on the clinical relevance of data contained within personal health records.”
- “Any data imported into a physician’s EMR/EHR from a patient’s personal health record (PHR) must preserve the source information of the original data and be further identified as to the PHR from which it was imported as additional source information to preserve an accurate audit trail.”
In addition, the AMA adopted a new policy to address the physician’s use of information contained in a PHR. Specifically, this policy includes the following elements:
- “To the extent that the physician chooses to review a PHR, the physician retains the right to exercise professional judgment in determining the clinical relevance of information contained within a PHR.
- “The physician is responsible only for the use of PHR data that the physician has actively chosen to incorporate into the patient-physician relationship; conversely, the physician bears no responsibility for PHR data that the physician has not actively and specifically incorporated into the patient’s active medical care.”
- “All data contained within a PHR must have accurate and verifiable attributions as to the originating source of the data.”
According to an article posted June 18th on ModernHealthcare.com, the delegates decided that “it was too early to call on Congress to pass legislation regulating still-evolving and little-used personal health records.”
The CMA has been quite active in promoting various technologies to digitize healthcare including, not surprisingly, EMRs. It will be interested to see if they follow their American cousins and approve resolutions related to PHR use.
I was having a look at the various resolutions passed at the CMA annual General Council meeting held earlier this month and discovered that there were a number of eHealth related resolutions:
- The Canadian Medical Association and provincial/territorial medical associations urge the federal government to immediately transfer to Canada Health Infoway the $500-million investment announced in the February 2009 Economic Action Plan in order to accelerate the adoption of electronic medical records in physician offices by 2011. (SS 7-28a)
- The Canadian Medical Association and provincial/territorial medical associations will work with governments to accelerate the introduction of e-prescribing in Canada to make it the main method of prescribing by 2012. (SS 7-31)
- The Canadian Medical Association and provincial/territorial medical associations urge governments to ensure that the $500-million investment in Canada Health Infoway announced in the February 2009 Economic Action Plan be available for up to two years following the transfer of the funding. (SS 7-29a)
- The Canadian Medical Association and provincial/territorial medical associations will work with governments to create, by Dec. 31, 2010, basic interoperability standards that will ensure secure, reliable, effective and rapid transmission of data across point-of-care information technology systems. (SS 7-30)
- The Canadian Medical Association will work with provincial/territorial medical associations to demand that governments recognize that the flow of information from the patient record to the electronic health records is the professional responsibility of physicians. (SS 7-36a)