Pharmacists and physicians connect for improved patient care
An EHR success story
In Sault Ste. Marie, EMRxtra makes electronic medical records in doctors' offices available to local pharmacists.
According to the Canadian Institute for Health Information (CIHI), total drug spending is estimated to have reached $29.8 billion in 2008, representing an annual growth rate of 8.3 per cent. Prescribed drugs are estimated to have accounted for 84 per cent of total drug spending in 2008. The widespread use of new medicines and the increasing prevalence of the conditions they treat have created an ever-growing challenge for doctors and their patients. Particularly for the one in three Canadians living with chronic health conditions, prescription drugs are essential — and dangerous if used incorrectly.
The Group Health Centre (GHC) in Sault Ste. Marie launched EMRxtra by extending its electronic medical record system, with patient consent, to local pharmacists. The aim was to reduce medical errors, improve patient safety and enhance collaboration between pharmacists and physicians. Partners in the $3.5-million project include Canada Health Infoway and the Ontario Pharmacists' Association, organizations that are interested in applying the technology and process in other regions.
Using advanced, secure medical software that was initially adopted by more than 100 of the GHC's doctors and allied health providers to improve workflow and patient outcomes, electronic medical records for patients in the pilot program were made available to all Sault Ste. Marie pharmacies.
Karen Madill, a former nurse who participated in this EMRxtra pilot project as a patient, illustrates the complexity of the challenge. "My health is very, very complicated," she says. "When I first moved back to the Sault, I was healthy. Then I developed lupus and then fibromyalgia, then osteoporosis and auto-immune hepatitis. I'm on about 30 different medications for various things. And now I've got asthma."
Lucy Fronzi, EMRxtra project manager, says, "The project allows the patient care team at the Group Health Centre to be linked through web services to the patient's pharmacist of choice. They share part of the medical chart, so the pharmacist is able to work with the patient with their own medical history."
Having access to those records helps pharmacists prevent dangerous drug interactions, and provide sound advice to the patient with the confidence that comes from being fully informed on the patient's medical history. The result is that the extensive expertise of the pharmacist becomes an important element in the 'circle of care' provided to the patient.
Dr. David Crookston is a family physician with the Algoma District Medical Group at GHC and participated in EMRxtra. "Pharmacists tell us that most of the time (access to the medical chart) clears up any misunderstanding or questions they might have about why a doctor is sending them a particular prescription," he says.
In the doctor's office, patients are still provided with paper prescriptions so they know what they are being prescribed, but the doctor also enters the prescription in the patient's electronic medical record for the pharmacist to review.
"I think doctors are aware that there is the potential for harm from (drug) interactions because that's the pharmacist's livelihood, they have a deeper understanding of how medications interact. The pharmacist will be able to say, 'Well, Doctor — had you considered that there may be a problem? Is there an alternative?' That's a very healthy interaction, and it's all for patient safety."
Sunny Loo, director of Information Technology at the Ontario Pharmacists' Association, says, "The EMRxtra project in Sault Ste. Marie is extremely important in terms of moving technology forward. It is the showpiece in Canada for innovation, for integration and collaborative health care. We work within the program to...insure that the technology can be transferable across Canada."
For patients who participated in this pilot program, the collaboration between their physicians and pharmacists has meant a new level of care and safety. "I love it, because everybody is involved," says Ms. Madill.
"I don't have to go through my history every time. They know my history. You've got a relationship with your pharmacist, and you're not scared to ask him anything. The level of care is excellent."
