Put e-records in every doctor's office, new CMA president says

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There should be electronic medical records in every physician's office by the end of 2011, the new president of the Canadian Medical Association says.

Meeting that ambitious goal is just one example of the kind of bold change that is required to make the health system effective, efficient, and patient-centred, Anne Doig said Wednesday in Saskatoon.

"Physicians know that electronic medical records are the essential building blocks to create an electronic health record capability across Canada," she said. "EMRs are also a necessity for effective patient care within an individual physician's office."

Canada Infoway, a non-profit agency whose role is to promote electronic health record systems, has set 2016 as a goal for full implementation in Canada.

But Dr. Doig said that timetable should be accelerated as part of the "transformation" of the health system. She also called on the federal government to invest in electronic medical records, in particular to free-up the $500-million it promised in the economic stimulus package to help doctors equip their offices with the necessary computer equipment and software.

In her inaugural address to the CMA, the group that represents Canada's 67,000 physicians, residents and medical students, Dr. Doig said that "building a better health-care system for Canada means first and foremost ensuring the system is meeting the needs of patients."

Currently, she said, those needs are simply not being met and that is unacceptable for physicians and patients alike.

The CMA president enumerated a series of "systemic failings" that she deemed unacceptable, including:

- Upward of five million Canadians do not have a family physician;

- Patients are "woefully under-covered" when it comes to prescription drugs;

- It is "normal procedure" for hospitals to allow patients to languish in hallways;

- Patients stay weeks and months in acute-care beds for lack of spaces in long-term-care facilities;

- Patients are discharged from hospital without a clear plan for their care in the community.

The Canadian Medical Association general council meeting had as its theme, "Health Care Transformation: We Can All Do Better."

It was widely expected that there would be fierce debate about how that transformation should take place but, in the end, delegates adopted a series of resolutions that were largely motherhood and apple pie, or dealt with very specific issues, and they left it to the CMA board of directors to piece it all together into a blueprint for reform.

One of the only points of contention came Wednesday when Andrew Kotaska, a physician from Yellowknife, put forward a resolution saying physicians providing medically necessary services in private clinics should not be allowed to bill more than the service would be reimbursed by the public system.

"This would prohibit extra-billing," he said.

But, after a lengthy debate, the motion was voted down with even physicians who oppose extra-billing, who argued that there are myriad fee differentials in the system.

In her inaugural address, Dr. Doig, a family physician who follows two CMA presidents who were owners of private medical clinics said the private-public debate is not black and white.

She took great pains to say that the CMA firmly supports medicare and that care delivered by private practitioners within a publicly administered system is perfectly acceptable if it improves access and quality of care.

"Canada's physicians have always stood four-square behind the principle that no Canadian should do without needed medical care because of an inability to pay. That is an irrefutable fact.

"Canada's physicians also stood four-square behind the principle that all Canadians must have appropriate access to the care they need. That too is an irrefutable fact," Dr. Doig said.

For her and most doctors, she said, the "issue is care, not medicare."