Electronic medical records: small can be idiosyncratic

In the article referring to Canada Health Infoway needing a watchdog,1 a few things should be considered. Thirty years ago, I was involved with a grass-roots approach to try to build an electronic medical record (EMR). It soon became clear that to develop a high-performance product was going to take a multimillion-dollar effort. I have since seen one attempt after another to do the same thing; typically the products are incomplete, use impoverished information models and have idiosyncratic functionality. The problem is that physicians keep buying these products.

In one instance, my office accumulated about 800 000 lab results over a 10-year period. When we changed to a different EMR vendor, the identifier for each test was wiped out because the provincial requirement did not include that identifier. The problem was that the needs of the end user were not being met by the laboratories using legacy systems, and that those who set the provincial requirements did not not recognize this as an issue.

The requirements for a high-performance EMR are not immediately apparent to typical clinical users. They don’t seem to be apparent to some EMR vendors who listen to those typical users. There seems to be a widespread awareness of the tremendous amount of work that has been done to determine EMR requirements. If this work was actually considered, we could have made an impressive leap forward in EMR functionality. However, there are so few people interested that there is no critical mass to perform the work on a small scale; a national effort is required.

Although there could be improvements at Infoway, I think the larger problem is that owners and funders of outdated legacy systems are not willing to move forward with systems that would be more conducive to delivering what is needed today.