Canada Health Infoway
Founded in 2001, Canada
Health Infoway was established to
facilitate the creation of a national electronic health record system that would
connect information gathered from various points of patient care and build a
comprehensive electronic record of a person’s medical history. Electronic
medical records (EMR) can not only increase collaboration & information
sharing between health care providers and thereby improve quality of care, but
can also enhance overall system efficiency by increasing individual provider productivity
and reducing service duplication.
Low User Adoption Rate
Despite these advantages however, and the
$1.6B dollars invested in building the infrastructure for e-records adoption,
implementation at the community level has been very slow in comparison to other
countries. In 2009, only 36% of Canadian
doctors were using EMR systems compared to over 90% in Australia, the United
Kingdom, New Zealand, and the Netherlands.
A number of factors have contributed to low user adoption rate; the
primary ones being the need for training to change work processes, lack of
adequate government funding, and contractor failure.
v
Lack
of IT Training
In many hospitals and physician offices, doctors use
a familiar system with colour-coded patient charts, which allows them to
quickly look for information as required.
Having to transition into a computerized system is a challenge because
the learning curve needed to master digital records to the same level that
physicians are currently working at with physical files is quite steep. And
this transition not only applies to physicians but also to thousands of
personnel working in healthcare, including nurses and unit clerks, who have to
be retrained to handle new equipment and new operational procedures.
v
Lack
of Adequate Funding
Dr. Brian Day, president of
the Canadian Medical Association, and Richard Alvarez, CEO of Canada Health
Infoway, cite lack of government attention to information technology in health
care for the low adoption rate. The $3B
dollars that has been allocated for this project is insufficient, according to
Alvarez, who states that implementing digital recording in doctor’s offices,
hospitals, and labs across the country will likely cost about $10B. A portion
of this funding can help private clinics deploy the necessary technology. Much
of the funding though should help doctors deal with the inevitable delays in
their practice during the transition period from physical to electronic
recording.
“Many doctors are often surprised by the
temporary decrease in the number of patients they are able to see during a
transition period that could take anywhere from 12 to 18 months.” states Dr.
Robert Boulay, president of the College of Family Physicians of Canada. “This
is the real crux of the implementation issue. So what the College really has
been trying to advocate for is for increased support for physicians while
they’re making that transition”.
Any funding for additional
support is of little consequence, however, if EMR system providers are unable
to provide ongoing reliable service.
Indeed, many systems offered by government approved providers have
failed, forcing physicians to relearn and adapt to multiple EMR systems. Some vendors refuse to make modifications to their
system to meet doctors’ needs, which not only reduces system usability, but
also discourages system adoption.
Best
Practice – Project Implementation Strategy
Many health information and technology experts state
that a national electronic health record system will likely not be realized in
Canada for another 20 years or more. No
single, definitive reason can fully explain why full-scale system adoption is a
challenge for Canada compared to other countries. A combination of factors
contributes to this issue, and must be taken into consideration to increase
user adoption level.
For one, communication
between government sponsors and healthcare providers must be improved upon to
allow for greater understanding regarding project goals and expectations, as
well as health system operational needs and resource requirements. Government funding for the project should
also be increased to support frontline healthcare workers and incentivize them
to transition from physical to electronic medical recording. Australia, for example, was able to greatly
improve physician participation rates by supporting system implementation, not
simply IT acquisition, and offering incentives for providers to submit claims
electronically.
Furthermore, EMR vendors
must be better regulated to reduce risks to primary care practices. Perhaps vendors should adopt common data
recording standards to allow for smooth transitions if system changes are
needed. Guidelines, standard procedures, and government regulations should also
be in place to help healthcare workers understand how best to deal with issues
regarding security, accessibility, confidentiality, storage, and destruction of
electronic data. Overcoming these hurdles may help Canada along its journey
towards establishing a national electronic health record system.
Posted by C. Liu.
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