News

When Karen Madill rushed to her hospital emergency room a couple of weeks ago, she forgot her list of prescriptions — an important oversight given that she has multiple health problems and takes about 30 different medications.

A couple of years ago, says the resident of Sault Ste. Marie, Ont., she would have needed that list before doctors could treat her, because of the potential for dangerous drug interactions. But now all of her records are available electronically, for immediate use by ER staff.

"They had all my meds all there, and they knew what I was on," says Ms. Madill. "It just gives good continuity of care."

That's what electronic health records (EHR) and electronic medical records (EMR) are all about — storing all of a patient's health information for use by medical professionals when needed. Though the two terms are sometimes used interchangeably, experts refer to systems within doctors' offices and clinics as EMR and those linking institutions as EHR. Ideally, the two work together, with doctors' EMRs connected to wider EHR systems.

Sault Ste. Marie's Group Health Centre was one of the Canadian pioneers in electronic records, building its initial system in 1997. Two years ago, the centre started a pilot project, known as EMRxtra, to extend the electronic system to pharmacists as well.

Today, all of the area's 23 pharmacies have access to the records of about 300 patients, including Ms. Madill, who have diabetes or congestive heart failure.

EMRxtra hopes to expand the access to those with other chronic diseases.

Electronic records are "the glue that holds this multifunctional team together," says Lewis O'Brien, lead physician for the EMRxtra project. Doctors have better information, he says, and can spend more time listening to patients instead of flipping through charts.

Shared information also helps pharmacists provide better care, says Sunny Loo, director of information technology and e-health at the Ontario Pharmacists Association. They can alert doctors to other drugs patients are taking and whether prescriptions are being filled.

It's all part of the promise of EHRs: if everyone dealing with a patient sees the whole picture, mistakes are less likely, care is more efficient, and health care costs are reduced.

At Toronto's University Health Network, 85 per cent to 90 per cent of patient information is now electronic, says Lydia Lee, UHN's chief information officer.

When patients leave hospital now, she says, electronic discharge summaries provide information much more efficiently to long-term care facilities, home-care workers and family physicians than old paper-based systems did.

And automated systems for tracking prescriptions — which Ms. Lee says UHN has implemented more extensively than most hospitals — have reduced adverse drug interactions.

That's important, because thousands die every year because of problems such as drug interactions, says Richard Alvarez, president and chief executive of Canada Health Infoway, a non-profit organization set up by the country's health ministers in 2001 to promote EHRs.

Though the health care sector depends upon accurate, up-to-date information, it has been slow to exploit information technology — mainly because of costs and resistance to change.

For years, IT was a low priority in health care, says Mr. Alvarez, and only recently have governments begun to realize that technology can save money in the long run.

He expects electronic hospital records systems should be in place across the country by about 2013.

Doctors' offices, however, are still lagging. A study by the New York-based Commonwealth Fund last year found that only 23 per cent of Canadian doctors use electronic medical records, compared with 98 per cent in the Netherlands, 92 per cent in New Zealand and 89 per cent in the United Kingdom. (U.S. doctors are no further ahead than Canadians.)

A key problem is that the cost of electronic records in a doctor's office falls mostly on the physician, while the benefit goes to the health care system as a whole.

"Many doctors feel that this is a benefit to the whole society," Dr. O'Brien says, "and so they are unwilling to bear that cost on their backs — and I think quite rightly."

Ms. Lee adds that the toughest part of making the switch to electronic records is "managing the human side of change." People are hesitant about new technology until they see how it benefits them, she says.

Dr. O'Brien says that's especially true for individual doctors and small clinics that do not have the IT expertise to help them implement and maintain technology.

Still, the benefits of shared records are clear, says Lucy Fronzi, EMRxtra's project manager. "It provides more continuity of care when you have all ...[who] are providing some kind of care to a patient having access to that information."

National EHR snapshot

• Alberta leads the way in electronic health records, says John Anders, senior director of business development at Bell Canada's Centre for Health Care Innovation, which provides EHR technology and services. He says Alberta started earlier, had ample funding, and was quicker to create regional links among health-care organizations than other provinces.
• British Columbia has pioneered systems for pharmacists to share drug information, says Richard Alvarez, president and chief executive of Canada Health Infoway.
• The four Atlantic provinces will move all X-ray images to a digital system by the end of this year, Mr. Alvarez says.
• Quebec has begun moving ahead rapidly in the past year, Mr. Anders says, while Ontario's recent budget included investments in EHRs, starting at $47-million this year and building to $239-million in 2010-2011.
• Nova Scotia is building a system to give doctors and health-care providers access to patient records through a Web portal. The system will help give health workers access to patients' medical history no matter where they are and aims to cut costs by reducing duplication of tests, among other things, says Lyn Kilroy, manager of business solutions for the provincial health department.

Special to The Globe and Mail