Posted on January 2, 2018 by Rashaad Bhyat
We live in the age of information.
Medicine in particular is experiencing a rapid expansion of the volume of knowledge1, and physicians must manage this information efficiently to care effectively for their patients.
A concurrent trend is the aging of the Canadian population. By 2036, seniors will account for up to 25 per cent of the population2. Canadians are living longer, with a greater burden of chronic diseases, meaning physicians are caring for patients with multiple, and increasingly complex medical issues.
Paper-based charts are simply no longer adequate for managing patient health information in the 21st century.
Electronic medical records (EMRs) are the information systems that physicians use to manage patient health information in their practices. EMRs have received unfavourable coverage in the mainstream media recently, primarily south of the border in the United States (where they are called EHRs, or electronic health records).
However, the US experience is not universal, and direct parallels should not necessarily be drawn to the Canadian experience.
Broadly, EMR systems in Canada have the ability to:
- Allow physicians to connect to provincial EHR repositories and local hospitals (containing information such as specialist reports, lab data, prescription data, and more). This provides physicians with vital information they need to provide informed care.
- Facilitate better, safer care for patients. EMRs, for example can reduce unnecessary, duplicate tests.
- Facilitate efficient medical office management, freeing up office staff for more important tasks.
- Set the stage for effective patient information management, at a population health level, as EMR data analysis can provide valuable insights for clinicians into their patients’ health.
- Set the stage for more patient-oriented services, such as e-booking, which can reduce no-shows and improve staff satisfaction.
- Set the stage for clinicians to embrace an EMR-enabled culture of continuous quality improvement.
- Improve the legibility of clinician notes, and thus enhancing clarity and safety of communication between health care providers (particularly those working in teams).
- Improve medication management and lay the foundations for true electronic prescribing, which can improve patient safety and reduce the potential for prescription fraud and misuse.
A recent article by Dr. Adam Stewart in the Medical Post reinforces a number of these arguments, using very effective clinical examples.
Another article by Dr. Michelle Griever et al. in the Canadian Family Physician journal similarly outlines why, despite the shortcomings of EMRs, most Canadian physicians would not go back to a paper-based world.
Relatively speaking, we are in a nascent phase of EMR adoption. We have only just recently reached a major milestone of 85 per cent EMR adoption amongst primary care physicians in Canada, according to the CMA Workforce Study 2017, and many physicians are not using EMRs to their full capacity.
What we must not forget is that adopting new technologies into clinical practice represents a big change for physicians, and change is not easy. It is for this reason that Dr. Thomas Bodenheimer and Dr. Christine Sinsky proposed expanding the IHI’s laudable Triple Aim (enhancing the patient experience, improving population health, and reducing costs) into a Quadruple Aim, by supporting those who deliver care. Clinician Peer Networks, EMR user groups, and support for change management strategies can help achieve this goal.
EMRs and related systems have become essential tools for physicians in the modern era. Their utility will continue to grow as medicine moves towards embracing a culture of continuous quality improvement, facilitated by digital health systems. EMRs will evolve over time, in the same way that the automobile morphed from the Ford Model T into the Tesla Model 3.
At some point in the future, we will look back and wonder what all the fuss was about.
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Dr. Rashaad Bhyat is a Clinical Leader in the Clinical Adoption group at Canada Health Infoway. He is a family physician with a special interest in Digital Health. He currently practices in an EMR-enabled family practice in the Greater Toronto Area.