by Nestor E. Arellano
What would it take to push forward a sluggish electronic patient records initiative? An embarrassing medical records fiasco of gargantuan proportion and one irate privacy commissioner perhaps?
In the case of Cancer Care Ontario (CCO) and Information and Privacy Commissioner (IPC) Dr. Ann Cavoukian at least that seems to be how things are shaping up.
Sometime in March this year, the CCO lost several packages of patient records pertaining to over 20,000 cancer patients. Since then investigations conducted have brought down the number of missing records (originally sent by CCO to various doctor’s offices via Canada Post’s Xpresspost courier service) to just 7,000 colon cancer screening reports.
In an unprecedented move yesterday, Cavoukian issued ordered CCO to stop the practice of sending out sensitive patient records in paper format. Cavoukian also gave the CCO until January 13 next year to show proof of compliance and report back to her office on their progress towards adopting an electronic medical records (EMR) system that will transmit the sensitive private data to doctor’s office through the Internet instead.
“I needed to give this strong order because the loss of 7,000 patient records is totally unacceptable. It could have been prevented,” Cavoukian told me yesterday. “They better comply with the order.”
As far back as last year, she said, results of a “pilot test” conducted by the CCO itself had advised the provincial cancer care body about the significant risks of sending out patient records in paper format but little action appeared to have been taken. “CCO should not have used a courier service to send paper-based records after that. Paper records could easily be read on face value, there are other more secure options,” Cavoukian said.
To the CCO’s credit, it has since accepted the commissioner’s position on not sending health records in paper format and decided to develop its own Web portal for delivery of screening reports.
However this whole episode can’t help but bring to mind the current sorry plight of the country’s EMR ambitions which after more than 10 years of planning and work is, in the opinion of many experts, still as much as 20 years away from full implementation.
Canada Health Infoway invested no less than $1.6 billion towards some 280 electronic health (e-health) projects across the country. But as of 2009, only 36 per cent of Canadian doctors were reported to be using EMR systems as compared to more than 90 per cent in Australia, the United Kingdom, New Zealand and the Netherlands.
Does the Infoway need a kick in the head as well to get it moving?
Of course there are some substantial differences between the CCO and Infoway cases. For example, CCO needs to consider it and Ontario physicians when developing an EMR system. On the other hand, Infoway is burdened by the disparate health records systems and policies of 12 provinces and the doctors in those jurisdictions.
The optimist in me, however, thinks that by cracking down on the CCO, Cavoukian may be giving the EMR push, at least in this province, a much needed shove.
Compelling the CCO to stop delivering screening reports to doctors’ office in paper format will, in effect, leave physicians with little choice but to adopt their practices to accept the handling of electronic patient records. But this can only go so far because the roots of the problem remain. 
The cost of investing in EMR systems, reliability of technology providers, re-training and work practice changes are all valid issues that physicians have raised as reasons for resisting the shift to electronic records.
Another cause for the foot dragging is that there is no compelling reason to change existing practices. The long term cost savings, security and efficiency taunted by the experts simply do not resonate with the majority of doctors.
A younger crop of doctors may be entering the field prepared to use EMR technology but as stats show as much as 70 per cent of physicians prefer to do it old school. Waiting for a younger tech savvy cohort to take over the landscape will still take decades.
To promote widespread EMR adoption, authorities should address the issues that make a shift unattractive. Infoway was laid the infrastructure for a medical records system now it should concentrate on the community level and address the concerns on physicians and health professionals in the small offices and health centres that will be required to alter their work practices.
