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Question: I’ve had the same family doctor for 20 years and I do like her. But my medical records are still on paper and my doctor has no plans to convert to an electronic system. That makes me wonder how up-to-date she is with other medical advances. What could be the hold-up?
Answer: Changing to electronic medical records (EMR) is a daunting task for physicians who have been in practice for a long time.
They have to go through their old paper files and decide what must be manually entered into the new system. A typical family doctor may have between 1,500 and 2,000 patients.
“It’s a huge job and a massive change in practise,” says Dr. Sharon Domb, division director of family practice at Sunnybrook Health Sciences Centre.
It’s particularly challenging for doctors who work alone – without the supports that come with a group practice. “If you have a large patient load, it’s hard to find the extra time or energy to do it,” says Dr. Darren Larsen, Chief Medical Information Officer for OntarioMD, an agency that helps doctors with the transition.
Over the years, provincial governments have offered various financial incentives to coax doctors into making the switch and a majority of physicians have moved in that direction.
But there are still holdouts and some may retire without ever embracing the digital age. (In Ontario, 18 percent of family doctors and 38 percent of specialists working in the community have not yet made the conversion.)
In the future, though, using paper records won’t be a viable option. “I believe that a robust and effective EMR will be more important to the physician than the stethoscope or other examination tools,” says Dr. Ilan Fischler, Physician-In-Chief at Ontario Shores Centre for Mental Health Sciences in Whitby, Ont.
An electronic system allows doctors to systemically search their patients’ records. That means they can quickly identify individuals who are due for cancer screening tests or behind on their vaccinations. Notices can then be sent to patients, reminding them to book an appointment. With paper records, that same task would have taken countless hours of reading through separate files. As Fischler puts it: “Without the ability to organize your clinical data in meaningful ways, you can’t do effective, preventative medicine.”
Electronic records can also help patients better understand how their actions affect their health. For example, with a couple of clicks on a computer, a doctor can create a chart that shows how well a diabetic’s blood-sugar levels are being controlled. “That’s a powerful tool, especially for patients who’ve started a new treatment – and they can actually see the results,” says Domb.
But possibly the biggest advantage of a digital system is that, in theory, it enables the easy exchange of diagnostic results and other information between the patient’s health care providers. That can help speed up treatment and avoid the costly duplication of tests. But the smooth transfer of data has been hard to achieve because many electronic systems don’t talk to one another.
The provinces have tackled the integration problem in various ways.
Alberta, for instance, set a goal back in 1997 to create a single repository of key health information – including laboratory and radiology test results, hospitalization reports and lists of prescribed medications – for everyone in the province.
Although there have been bumps along the way, Alberta has basically reached its target, says Dr. Robert Hayward, Chief Medical Information Officer for Alberta Health Services.
“It’s like a public utility,” Hayward explains. “Your health care providers can sign in and access this information no matter where they are in the province.”
What’s more, Alberta recently opened up an online portal that will permit patients to see their health data. They can also use the portal to “record their own health history and track observations about any chronic problems they may have,” Hayward says. In a separate pilot project underway in the Edmonton area, patients can book appointments and get additional information from their doctors electronically.
It’s been a different story in Ontario, where the province adopted a local approach with health data collected into regional hubs. The plan is to eventually connect the networks together. But a report released last year by Ontario’s Auditor General noted that the province failed to meet its own target of implementing “a fully operational” electronic health record system across Ontario by 2015. Ontario also seems far from being able to open up a portal so patients can view their test results, as Alberta has just done.
Larsen is a strong believer that patients should have complete access to their health and medical records – including notes made by their health care providers.
But what do you do if your family physician is stuck in the past and is still using paper? Larsen says he would not suggest leaving such a doctor, especially if you have a good relationship. “The relationship with the physician is significantly more important than how she documents her notes.”
Even so, he’s convinced that digital is the best approach. Once a system is up and running, it’s easier for the doctor and better for the patient.
Sunnybrook’s Patient Navigation Advisor provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.
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A recently published study in at the University of Calgary cites the negative impacts of computer use in healthcare. The research team collected observational data from three ICUs and also talked to patients and families. It was also suggested that more research is required to determine the effects on health outcomes.
http://globalnews.ca/news/3268574/health-technology-hurting-patient-care-university-of-calgary-study/
http://www.newswire.ca/news-releases/is-your-doctors-use-of-technology-hurting-health-care-new-report-shows-negative-impacts-of-computer-use-in-medical-profession-614626864.html
I certainly have not seen any increase in productivity in the use of electronic medical records. Personally my productivity has declined by about twenty percent. As the emrs get more complicated and the teams get bigger the emrs get slower. At times they crash and for variable periods of time we have no records (5-60 min). They are expensive. If you have lots of money to buy new computers every 3-4 years you can upgrade to keep things reasonably fast but that is a lot of money. In my first 15 years of family practice paper charts worked quite well. It was faster to flip through an organized stack of paper than to wait for a screen to repeatedly refresh. Along with EMRs seem to come an obsession with documenting every little thing. Doctors don’t look at patients, my mom calls her family doctor “doctor computer”. We have these passionate promoters of emrs but if you know these people they tend to also be passionate about technology. It is often their hobby. Nothing wrong with a hobby but I would rather go for a run. It is not unusual to see family doctors who see ten patients in a half day and 15-20 in a full day the usual 20 years ago was 25-35. No wonder despite the fact we have graduated thousands more family doctors people still have problems with access.
My experience in converting to electronic records has been poor. Overall I find that that I am less efficient and often feel more like a data monkey and less like a doctor. Our system is slow, requiring too many clicks to do simple tasks and waiting for windows to open and the printer to warm up…. Over and over again.
As for your example of being able to search for patients who need PAPs, our system can’t recognize a PAP from any other lab test. So I have to open up a separate part of the EMR and enter patients on by one into the tracking system… more time staring at a screen and not at patients.
While computers have advanced and COULD be helpful as medical databases, our system looks like it was built in the early 1990’s by a high school computer club… and then then evolved by add-one that don’t plug and play well together. It’s constantly crashing. And for all this we pay tens of thousands of dollars, some of which are subsidized by tax dollars. Too make matters worse, to my eye, the EMRs haven’t seemed to evolve much at all over the past ten years.
It’s too bad that physicians don’t advocate for far better systems.
Well, he’s wrong. Reduced productivity, increased time required to complete tasks, reduced Dr – Pt ‘actual’ person contact time, reduced eye contact, reduced quality of clinical information entry, reduced physical examination of pt, increased test ordering, increased costs, and no evidence that ‘quality of care’ had improved.
If anything, EMRs are evolving to suit the needs of niche practitioners. Consider the e-Charting app produced by InnoCare; it’s specifically tailored to the needs of physiotherapists, massage therapists, and chiropractors. Meaning, that careful consideration, and extensive testing were put into the UX, UI, and workflow integration of the software. This makes completing tasks (like filling out insurance paperwork) easier than with paper charting.
Not only that, studies show that patients perceive a higher quality of care when a clinician uses and EMR (a point touched on in this article) and 62.8% of physicians (and 50.4% of specialists) say that the care they provide has become better since switching to electronic medical records. While I understand that change can be challenging, study after study is showing digitization is improving both the delivery of care and the patient experience.
Resources:
https://healthit.ahrq.gov/sites/default/files/docs/citation/09-10-0091-2-EF.pdf
https://www.cma.ca/Assets/assets-library/document/en/advocacy/Enhanced-Use-of-EMRs-Discussion-Paper-Final-May-2014.pdf
https://innocaresoftware.ca/charting