CMAJ • May 6, 2008; 178 (10). doi:10.1503/cmaj.1080032.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tevaarwerk, G. J.M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tevaarwerk, G. J.M., MD

Letters

Electronic medical records

Gerald J.M. Tevaarwerk, MD

Professor Emeritus, University of Western Ontario, Victoria, BC

A recent editorial by Ken Flegel repeats the purported advantages of keeping electronic medical records.1 The results of the electronic conversion of paper records in other industries suggest that such a conversion in medicine will be a boon to patients, payers and providers. Surprisingly, however, there is a paucity of trials measuring the benefits of introducing electronic medical records.2

The best study, conducted in Montréal, found that physicians and nurses needed considerably more time for electronic than for traditional medical record-keeping.3 A small office-based study found that it took about an extra one-half clinic day per week to keep electronic medical records compared with paper charts.4 On a positive note, a systematic review found that the need for repeat investigational interventions and drug use decreased in a primary care setting with the use of electronic medical records.5 However, the main effect reported in this US study was an improvement in the billing profile of the physicians who used it. Other researchers have questioned whether the widespread introduction of electronic medical records will save money.6

What is clear is that the current proposals by Canadian payers (the provinces) to support physicians who adopt electronic medical record- keeping fall far short of what is needed. It is informative to look at countries such as the Netherlands, where the penetration of electronic medical records is greater than 98%: not only are all hardware and software costs completely reimbursed, the remuneration system has been changed from a simple fee-for-service system to a blended scheme that reimburses physicians for the extra time needed to keep electronic records. In addition, hospital-based call centres have been supported, which are manned by community-based physicians who rely greatly on the electronic medical records for one another's patients.

Footnotes

Competing interests: None declared.


REFERENCES

  1. Flegel K. Getting to the electronic medical record. CMAJ 2008;178:531.[Free Full Text]
  2. Tevaarwerk G. Head-to-head comparisons of EMR systems with paper records: What is the current evidence? [blog post] 2006 Sep 23. Available: http://emruser.typepad.com/canadianemr/a_general_discussion/ (accessed 2008 Mar 31).
  3. Poissant L, Pereira J, Tamblyn R, et al. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005;12:505-16.[CrossRef][Medline]
  4. Brooks C. MDs who use paper charts versus electronic system save time. Med Post 2006 May 23:22.
  5. Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med 2003;114:397-403.[CrossRef][Medline]
  6. Siderow J. It ain't necessarily so: the electronic health record and the unlikely prospect of reducing healthcare costs. Health Aff 2006;25:1079-85.[Abstract/Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Tevaarwerk, G. J.M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Tevaarwerk, G. J.M., MD