Is failing to use an EMR unprofessional conduct?


It has come to this.

Some hospitals in Toronto are starting to use virtual reality in patient care (to help ease pre-operative anxiety). Yet, there are still family physicians in the province using paper charts to record and monitor the health of their patients: Not many for sure and far, far fewer than a decade ago an (an increase from 37% to 73% between 2009 and 2015).

But nonetheless, in an era where the health technology envelope is being pushed harder and faster than ever before, the most recent international comparison of use of electronic medical records (EMRs) by family doctors shows Canada continues to lag behind countries such as the U.K. and New Zealand where use is almost universal.

This finding comes from a study released earlier this year by the Canadian Institute for Health Information (CIHI) in partnership with the Canadian Institutes of Health Research, and with co-funding from Canada Health Infoway looking at data from the Commonwealth Fund 2015 survey of 10 countries.

Maybe the time has come to seriously ask whether the acceptable standard of care for family doctors practising in Canada involves using an EMR and that failure to do so could be seen as failing to maintain that professional standard.

It is a question that was first asked quietly more than a decade ago, back in the twilight era when only the most forward looking physicians and jurisdictions were using EMRs routinely. Now, when EMRs have hugely increased functionality and proved their value in efficiently managing the health of populations, the question can surely be asked with more authority.

Of course, nobody wants to force some physicians to use technology they don’t like, don’t understand, and which can sometimes lead to gross inefficiencies in the use of their time. In fact we can imagine there may be parts of the country where a physician still cannot even purchase a reliable EMR. And we in Canada still struggle with interconnectivity and many family doctors remain stranded on ‘electronic islands’ unable to use their EMR to communicate effectively with others in their community.

But the reality is that electronic storage of patient data is here to stay whether the medical profession likes it or not.  With almost three quarters of Canadian family physicians now using EMRs for patient care the time has to come to ask medical licensing authorities whether they need to apply more diligence to observing those doctors who choose not to rely on paper records.

The failure of family doctors to totally embrace electronic records is hindering both patient care management and population health management. Even of those who use EMRs, the CIH report notes fewer than half routinely use the system for at least 2 of the following: electronic alerts or prompts about a potential problem with drug dose or drug interaction; reminder notices for patients when it is time for regular preventive or follow-up care; alerts or prompts to provide patients with test results; and/or reminders for guideline-based interventions and/or screening tests.

Surely the time has come for this to change.


3 thoughts on “Is failing to use an EMR unprofessional conduct?

  1. Great post Pat! Using an EMR can be daunting, but the good news is that there is help for doctors who want to adopt an EMR or want to learn how to use their EMR better for patient care or to automate processes in their practices. OntarioMD has Physician Peer Leaders who are expert EMR users who can sit down with physicians at their convenience to mentor them as they learn how to do more with their EMRs. There are also about 50 Practice Advisors spread across the province that can work with physicians and their staff to eliminate pain points and leverage the EMR to focus on the practices’ needs. No physician has learn how to use their EMR alone! If physicians and/or their staff can spare the time, I also recommend OntarioMD’s EMR Every Step Conferences, where in just one day, they can learn a lot about their EMRs – advice, tips, EMR training workshops, demos, and more. Visit to learn more about these services. OntarioMD is here to help!

  2. This is a ridiculous article, and one more reason for doctors to pack it in and retire. I was in an office with an EMR for four years, and it was an absolute scam for the doctors, not just in the initial set up fees, but in the never-ending “compulsory upgrades” than never cost under 4 digits. Every time a new doctor joined our clinic, we had to cough out a $400 “set-up fee” so someone from PSS could type in some secret code and allow a new password to be set. Once, after spending over 30K on new Mac computers for every treatment room, we were told LESS THAN 6 months later that it was time for a “compulsory upgrade”: and that this upgrade was not compatible with the current computers! I am back to paper charts now, and have had nothing but positive comments from patients who are happy that “you actually look at me now while I’m talking!”

    There are multiple surveys available that EMR actually decreases both patient and MD satisfaction with the quality of the interaction.

    When the day comes when the EMR is 100% funded by the MOH, AND the computer will voice-populate charts with detailed templates so I don’t have to be searching through drop-down menus instead of listening, I will reconsider.

    Meanwhile, it is absolutely asinine to insinuate that doctors who don’t give in to pressure and spend a significant part of their dwindling take-home pay on EMRs that make their charting more laborious, are not practicing “standard of care”. Standard of care is exactly that: CARE. It is not charting. It is not gizmos. And it is certainly not staring at a computer screen when a human being is trying to talk to you!

  3. Most doctors aren’t technically savvy and they are the ones getting ripped off just like you would be ripped off by your auto mechanic if you know nothing about cars. The ones who are techically savvy ARE EMBRACING EMR and modifying it to their own needs. The technology is mature now for voice charting. It is even included in all Macs.

    EMR and AI support in the future will change how we practice medicine using big data and individualized data.

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