Is failing to use an EMR unprofessional conduct?

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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.

#Ehealth2016 – inquiring minds want to know

 

ehealth_ambassadors_badge_300x300Canada’s premier conference on health information technology – #ehealth2016 – is now less than a month away.

That means it’s a good time to start to contemplate some of the big questions facing the health IT community in Canada and wondering whether this mega-meeting hosted in Vancouver.\, courtesy of COACH, Infoway and CIHI will provide any answers to these questions.

At its worst, this annual meeting can be an annoying combination of sometimes irrelevant keynote speakers and simultaneous sessions that do not live up to their titles/abstracts. But over the past decade e-health (however one chooses to write the name – hyphen, no hyphen, capital on ‘e’ or no capital on ‘e’ etc.) has become THE meeting for those interested in health IT to network, hear leaders in the field and gain insights into really interesting work going on at local/regional and provincial/territorial levels.

As an observer, I would suggest a few interesting questions this conference may help to provide answers for:

  • With the death or evolution of the big dinosaur programs for funding physician EMRs (POSP, PITO etc.) what is being done to continue to involve and engage physicians in improving how they use electronic records to improve care?
  • What is Infoway planning on doing with its new infusion of funding courtesy of the last federal budget?
  • Is patient engagement a thing in Canada in health IT and if so what does it mean?
  • Is the vendor space for EMRs and EHRs going to continue to consolidate ?
  • And that interoperability issue – is anything substantive happening to better connect physicians and hospitals.
  • Big data. (enough said).
  • Are hospitals and practitioners adapting to the mobile revolution in health?
  • Are these the correct questions to be asking? At HIMSS this year there was a big shift towards discussing digital connectivity beyond the electronic record and major discussions about data security in health. Should Canada be having those discussions too.

Inquiring minds want to know.

 

To the EMR … and beyond

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For a conference that was about health information technology, it was all about health IT.

Allow me to explain.

The annual meeting of the Canadian Agency for Drugs and Technology in Health (@CADTH_ACMTS) is a showcase for health technology assessment (HTA) and the mission of the organization is to provide credible, impartial advice and evidence-based information about the effectiveness and cost-effectiveness of drugs and other health technologies.

What was noteworthy about this year’s meeting in Ottawa –  the largest yet for the organization with about 750 attendees – was the number of times electronic records (either EMRs or EHRs) were referenced as an essential feature for both gathering and for disseminating credible information to support evidence-based medicine.

Physician speakers repeatedly noted the need to have easy, point-of-care access at the time of the patient encounter, and to all of them this meant embedding that information in the electronic record.

More than one family doctor talked about being overwhelmed with guidelines and best practices and the need to integrate this information into the physician workflow to be useful – and EMRs as the natural place to do this.

The Canadian Association of Radiologists creates world-class clinical practice guidelines, but as Dr. Martin Reed, a pediatric radiologist from Edmonton told the meeting, one of the problems with these guidelines is that it is very hard to get people to use them.

He said there is now a feeling in the medical imaging community that the best way to do this is to integrate the guidelines into CPOE (computerized physician order entry) systems.

Given that some Canadian physicians still do not use EMRs and some (many?) hospitals are not using CPOE this could raise concerns about the quality of care being delivered.

On this information gathering front, the new focus on real-world data has placed an increased emphasis on the value of EMRs or EHRs to gather useful information to evaluate the effectiveness of drugs and technologies, the meeting was told.

“The starting point is having an EHR covering all of the caregivers. At that point the world is your oyster,” said Dr. Murray Ross (@murrayrossphd), leader of the Kaiser Institute for Health Policy in Oakland, CA.

Dr. C. Bernie Good (@CBGood23) who holds numerous roles with the US Department of Veterans Affairs gave numerous examples of how the extensive database gathered on VA patients through EHRs has helped support evidence-based drug prescribing.

And it does not end there.

As Anil Arora, assistant deputy minister in the Health Products and Food Branch, of Health Canada told the meeting it is not just the information being gathered in patient records that will need to be taken into consideration in the future – but also the wealth of patient data now being collected through wearables and other devices as well as through social media.

Given that we have by no means maximized the value of EMRs to gather this information in Canada, the challenges of extending the information sources to other digital repositories of patient information is currently problematic to say the least.

(Picture – Anil Arora. Courtesy CADTH)