Don’t hold your breath over Canadian doctors fully adopting an electronic medical record (EMR) system any time soon.
Health information and technology experts say it will likely take another 20 years or more before the e-health dream is fully realized in the country.
“Canada Health Infoway has been at it for 10 years, but I don’t think we’ll see full e-records implementation in 50 years…well that’s an exaggeration, its more likely 20 years,” said Gail Crook, CEO and registrar of the Canadian Health and Information Management Association (CHIMA). The CHIMA represents more than 3,700 health information management professionals employed in hospitals, community health centres, education systems and government offices across the country. Crook spoke during a debate on medical records security sponsored by document destruction company, Shred-it Canada.
Infoway, the government funded, not-for-profit corporation created in 2001 to foster the creation of a national electronic health record system (EHR), has laid the infrastructure for e-records adoption but widespread implementation at the community level still needs to take place, Crook said. 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, according to a study by the Canadian Medical Association Journal (CMAJ).
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“There are two main issues holding back EMR adoption: The need for training that will bring about a change in work processes and lack of funding for physicians to deploy the necessary technology,” Crook told ITBusiness.ca.
She argued that transformation is not just a mater of getting older doctors to start using computers as is often portrayed in news articles. “We are talking about tens of thousands of physicians, nurses and secretaries retraining to handle new equipment and changing their work style around the technology.”
Less paper society
Kerry Johnson, senior lecturer for health information management (HIM) at the University of Ontario’s Institute of Technology, agrees.
“We’re not going to really see a paperless society. It will be a less paper society,” he said.
“Many doctors are not going to give up their physical patient files simply because they are used to it and they can work very fast with it,” he said.
The learning curve required to master digital records to the level doctors are currently working at with physical files may be a hurdle, said Johnson.
“In large hospitals and small offices, doctors are very familiar with the colour-coded files and charts they know which sections to dive into when they’re looking for information,” Johnson said. “It is not going to be as fast for them if they have to learn to key in searches on a computer.”
According to Johnson, what the environment is currently shaping up to be is a hybrid workplace where electronic and physical records are being used.
Crook said CHIMA estimates that 90 per cent of hospitals in Canada are actually in this hybrid situation, but that only 10 to 30 per cent of patient records are in electronic form.
For some doctors the challenges are around the reliability of EMR providers. For instance, Dr. John Fernandes, a physician based in Albeta says he has been through three different EMR systems.
“Many doctors in Alberta who deployed EMR systems are disillusioned because of the unreliability of the providers available in the province,” he said. Fernandez said many of the systems offered by government approved providers failed or the vendors refused to adopt the systems to meet the doctors’ needs.
In an interview with the Canadian Medical Association Journal, Dr. Robert Boulay, president of the College of Family Physicians of Canada (CFPC) said he believes doctors can deal with the upfront cost of technology deployment. Boulay, however said, many doctors are often by 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.
“I think that’s the real crux of the implementation issue. So what the CFPC really has been trying to advocate for is for increased support for physicians while they’re making that transition,” he said.
Securing patient information
When they do take the leap to digital or electronic records, physicians have to revise their view of patient records protection as well, according to Michael Collins, vice president of Shred-it Canada.
For one thing, he said, they will now have two sets of data to protect: The physical file; and the digital files.
“More than ever, doctors, clinic staff or hospital administrators need to device rules and procedures regarding who will have their authority to view or handle which type of information,” Collin said.
The back-up and destruction of both physical and digital files is another issue he said.
Doctors need to determine:
- Which patient data they should store in physical form and digital form
- The location and reputation of their physical data and digital data storage provider
- Appropriate data destruction policies that comply with industry and jurisdictional standards
Collins stressed that patient records contain vital information that criminals can use to forge an identity or to commit fraud. “In Canada, a social insurance number and a health card number will enable a person to secure a Canadian passport. With those pieces of information a person can easily falsify identity or commit fraud.”
In other countries where there is no national healthcare insurance, medical records theft is often linked to insurance fraud said Johnson of the U of T.
“Medical information and the identity linked to it is used to enable someone with a medical insurance to access to that service,” Johnson said.
Collins also gave the following advice on how to protect patient records:
- Shred the document or destroying the media before dumping them
- Incinerating documents
- Do not pass information to unknown individuals or organizations
- Do not provide information to unknown Web sites not certified by security authorities
- Keep computers, laptops and files in a secure place and away from reach of other individuals entering the office
If a breach does occur, Collin said, the doctor or healthcare facility manager should inform patients as soon as possible. Patients should be informed of:
- Date and time that the breach is believed to have occurred
- What type of information belonging to the patient was stolen
- How this breach may affect the patient
- What action should the patient take and whom should they contact
- What action the doctor or facility is taking to address the breach
