Canadian physicians playing “catch-up” in adopting electronic medical records

Canadian doctors lag behind their counterparts in many other developed nations in adopting basic electronic medical records largely because the emphasis in Canada has been on “the big building blocks” of electronic health records, says Bill Pascal, chief technology officer for the Canadian Medical Association.

“When you look at how far countries have moved towards a broader vision of electronic health information capability, Canada is not doing too badly,” Pascal says.

Comparatively less attention has gone to promoting the uptake of electronic medical records in physician offices in Canada, he adds. The lack of financial incentives and support for physicians to make the transition from paper records is also an issue.

Perhaps even more challenging than cost is the fact that “integration into workflow takes time, is likely to have a short-term negative impact and requires good change management practices to be successful,” says Khaled El Emam, Canada Research Chair in Electronic Health Information at the University of Ottawa in Ontario.

Those factors may help to explain the findings of a recent international survey which found that there is a “striking spread” across 11 developed countries in the adoption of electronic medical records (Health Affairs 2009;28[6]:w1171–w1183).

A Survey of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences found that only 37% of Canadian family physician respondents used electronic medical records in their practices, the lowest rate among the countries surveyed.

The 37% uptake represented an increase since 2006, when a study conducted for Canada Health Infoway found that 20% of Canadian family doctors used electronic medical records.

But Canada’s overall performance pales in contrast to rates in other countries: 99% of family doctors in the Netherlands use electronic medical records, and rates were in the 90s for Australia, Italy, New Zealand, Norway, Sweden and the United Kingdom. As well, Germany (72%), France (68%) and the United States (46%) all ranked above Canada.

Of course, electronic medical records in physician offices are only one piece of the larger electronic health record landscape, which includes other health information systems such as digitized lab results and prescription drug records.

If the electronic records “just reside on a desktop,” and there isn’t a lot of data integration with other systems, it’s not easy to see the benefits, says Kevin Leonard, a health policy, management and evaluation professor at the University of Toronto in Ontario.

The survey also revealed that Canadian family doctors again scored at the bottom with regard to the extent to which they used electronic means of performing functions such as gaining access to patients’ lab results and prescription drug information, or ordering medications and tests. Canada had the largest proportion (65%) of respondents who reported a low degree of electronic information functions, according to the survey, which was supported by the New York City, New York-based private foundation the Commonwealth Fund.

Financial incentives, standards and technical support at the national level supported the spread of electronic medical records in those countries with near-universal takeup, states the survey.

In Canada, the priority of Canada Health Infoway has been to help provinces develop repositories for information about prescription drugs, lab results and diagnostic imaging results, as well as to develop telehealth. The federally funded, nonprofit organization makes financial contributions to provincial health information technology initiatives.

Chief Executive Officer Richard Alvarez says that when Infoway was established there was “no appetite” among provinces to support electronic medical records. “So at a national level we had to make some difficult choices,” and a decision was made to “prepare the ground” by building the repositories so there would be value for physicians when they adopted electronic medical records.

“Now we are trying to play catch-up with the rest of the world” with respect to the adoption by physicians of electronic medical records, he adds.

Infoway was planning to spend $215 million of its most recent $500-million federal allocation on providing support for physician adoption of electronic medical records. But the federal government is withholding the $500 million until it completes a review of the national initiative.

Four national organizations, including the Canadian Medical Association, are urging that the monies be released. A 2009 CMA status report, Information technology and health care in Canada, states that there has been “significant growth” since 2007 in provincial programs to support electronic medical record initiatives. Five provinces now have such programs in place.

As well, the federal budget for fiscal year 2009/10 allowed physicians to deduct the total cost, in the first year, of eligible computer hardware and software purchases until early 2011.

But the CMA report indicates that the proportion of all doctors “using electronic charts exclusively in main patient setting” ranged from a low of 3.8% in Quebec to a high of 21.7% in Alberta.

Alberta also led the way in development of electronic health records, and key components such as drug and laboratory information systems are 95% to 100% complete in the province.

Family doctors in Canada are more likely than specialists to have adopted electronic medical records as “very little effort has been devoted to understanding the information requirements of specialists in relation to EMRs [electronic medical records],” the report adds.