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Electronic Medical Rumblings
(EMR - Electronic Medical Records)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

A shortened version of this article was printed on page 34
in the October 20, 2010 issue of The Mississauga News
under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

Just about every doctor I know is flushed with computers. They are used for just about everything that normal businesses use computer for, such as scheduling, letters, billing, information searching, communication with colleagues and local hospitals, and so on. What is not yet on my computer is the intimate part of people's health records. Electronic Medical Record keeping or "EMR" for short is in the news, because big bucks are at stake. The federal government is putting up $380 million towards EMR, and building a health info network. In today's world, the health care of a complex patient is fractionated into numerous micro-segments. Among these are diagnostics, labs, specialists, treatments, home-care, pharmacies, clinics, health departments, distant hospitals, Para-health people, and others. Patients may have 20 or more interactions between visits. Even though family docs are referred to as "gate-keepers", we are usually in the dark about activity other than that ordered directly by us.

In a perfect world, there is not a physician I know that would object to having an updated summary of a patient's medical interactions when they see them. Attempts to do just this now date back over twenty years when a fellow board member of my CCAC introduced the concept of a "smart chip" in health cards that would track and record your journeys in our complex health system. Concerns over privacy killed the concept. There is not a computer security code in the world that can match the intricate personal short-forms found within a physician's hand scrawl.

It is curiously odd that a process aiming at precise information is plagued with misinformation. One rumor suggests that only one-third of physicians have embraced computer technology? Newsflash: You cannot practice in Ontario without using a computer to talk to OHIP. Many physicians I know were weaned on Fortran when "K" memory was huge. Throwing dollars at EMR without a solid sub-structure in place will do little to bridge the black holes of information gaps. Repeated experience of being left "holding the financial bag" with hidden after-costs of new incentives has produced a weary group.

To embark on the EMR journey of digitalizing and putting your personal information on the web is a daunting task. The security aspect alone can be argued for hours. Do we really want those discrete STD rashes in plain but secure view? In Canada, there is no one product on the market to accomplish this. Physicians have to deal with numerous and pricey vendors about a subject totally foreign to them. They rely on commissioned sales people as their source of information. It strikes me odd how a wide network can be built with several different products. As an example, consider your local transit authority trying to build a new system by giving each driver a chunk of money and telling them to go out and buy the bus of their choosing. To sweeten the deal, they throw in free gas and oil changes for a year. Some drivers soon return with shiny new buses, full of bells and whistles, all painted the same but all different makes. They soon discover that the bus terminals don't have interconnecting routes, and they are free to build them as they please. Not a bus many docs are ready to board yet.

The concept is attractive to a new doctor. I need to accurately shred a quarter million pieces of paper into electronic bits. It is a very expensive headache, and down-played as a slight start-up inconvenience. EMR will change how I interact with patients. My head will be buried at a computer terminal busily punching in data, and reading pop-up messages. Maybe you won't need to come in at all. I could close the office and outsource the practice. For the foreseeable future, I still won't know which clinics you went to, tests that other physicians performed, new drugs other doctors prescribed, and your frustration will grow. I expect it will function about as smoothly as the crashing, freezing, deleting systems I have been trained on, only with more passwords to memorize. And I honestly do have enough real viruses to deal with as it is.

There is no question that our health info is going digital. Who pays and how it gets there is still being decided. But what would Grisholm do? My idea of EMR is one of those slick lap-tops from the cool blue room of CSI-Vegas that can accurately pinpoint the location of every nose hair you ever clipped. But this is Canada, and an American solution is just not right, eh? The cardinal rule of computer 101 is that any health decision is only as good as that data in the box. Don't forget to visit the cyber office for your flu-shot.

Related resources:

CBC News In Depth: Health care - Health records. Canada lags in electronic medical records. By Grant Buckler, January 28, 2008. "According to a Commonwealth Fund study conducted in 2007, only 23 per cent of Canadian physicians use some form of electronic medical record. That compares to 98 per cent in the Netherlands, 92 per cent in New Zealand, 89 per cent in the U.K. and 79 per cent in Australia."

CanadianEMR. EMR vendor comparisons, ratings and expert discussions. Canadian EMR is a site designed for physicians by physicians to help them through the tricky process of acquiring an EMR system.

Electronic Medical Records (EMR) from Professional Association of Internes and Residents of Ontario (PAIRO). "Health Canada would like half of all Canadian medical records electronic by 2009 . . . To support this, both Alberta and Ontario have created provincial bodies to assist physicians."

Electronic Medical Records - Successful EMR adoption: optimizing your workflow by Stephen McLaren, BSc, MD, CCFP, FCFP, from OntarioMD.

Technology - Saying goodbye to paper by Dr. Aya Suzuki, Arnprior and District Family Health Group, from OntarioMD. "The initial challenge of implementing the EMR system took roughly a year - ironing out all of the technical glitches and making sure the clinic staff was comfortable working with the technology . . . The payoffs for the effort to adopt an EMR are efficiency, better record-keeping, and I feel I can offer better care to my patients."

New EMR Adoption Program FAQs. Include: What is an electronic medical record (EMR)? "An electronic medical record is a computer-based medical record that is specific to one physician, practice or organization. It is the record that a doctor maintains for his or her own patients which details demographics, medical and drug history, and diagnostic information such as laboratory results and findings from diagnostic imaging. In Ontario, it is integrated with other software that manages activities such as billing and scheduling." How is an electronic medical record (EMR) different from an electronic health record (EHR)? Who can apply for the New EMR Adopter Funding?

EMR Adoption Program - New EMR Adopter Funding - Terms and Conditions from OntarioMD.

EMR Adoption Program - New EMR Adopter Funding - Funding Application. This form is used by community-based physicians, both family practitioners and specialists, to apply for New EMR Adopter Funding, from OntarioMD.

Health Information Technology (Health IT) from U.S. Department of Health & Human Services.

Certified Health IT Product List from United States Office of the National Coordinator (ONC) for Health Information Technology. A listing of electronic health record products certified by the ONC-Authorized Testing and Certification Bodies. Certified HIT Product List (CHPL) provides a comprehensive listing of Complete EHRs and EHR Modules that have been tested and certified under the Temporary Certification Program maintained by the Office of the National Coordinator for Health IT (ONC).

The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care - Framework for Strategic Action, July 21, 2004. By Tommy G. Thompson, Secretary of Health and Human Services; and David J. Brailer, MD, PhD, National Coordinator for Health Information Technology.

Progress continues with adoption of health information technology but significant barriers still exist from Health Forum. "CHICAGO, July 7, 2010 -- Hospitals understand the importance of health information technology (IT) and the benefits of its widespread adoption, yet as a field still face significant barriers to implementation according to a newly released survey of America's Most Wired hospitals and health systems."

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