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Electronic patient records will soon end doctor's scrawl on paper

Nurse Sedi Aboutalebi uses a scanner to read a barcode imbedded on patient Ken Seetaram's wristband at Toronto's St. Michael's Hospital April 11, 2011.

Moe Doiron/The Globe and Mail/Moe Doiron/The Globe and Mail

Three Canadian hospitals are finally taking significant strides in transforming paper medical charts to electronic patient records.

Two hospitals in the GTA - St. Michael's and North York General Hospital - as well as one in British Columbia have introduced a new barcode technology that allows healthcare workers to prescribe medication, order tests and deliver safer patient care all with a pass of a scanner. It's already been implemented by more than 200 American hospitals, but the days of squinting to decipher a doctor's untidy scrawl on a handwritten prescription will soon be a thing of the past here, too.

The Canadian Institute for Health Improvement estimates in 2010 that medication errors affect more than one million patients each year. Of that number, more than 700 patients die every year in Canada, as a result of preventable medication mistakes.

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Under this new barcoding system, physicians enter the prescription into a computer. The order is sent to the pharmacist, who validates the prescription electronically and places the medication on a drug cart - also equipped with a mobile computer - which is sent back to the patient's unit. Nurses then scan a unique barcode encrypted with specific instructions - it has to be the right drug, at the proper dosage, at the correct time and delivery method and matched to the patient's barcode, which he/she will wear on a wristband.

"It's a safety net for patients, doctors and nurses," said Anne Trafford, vice-president of information management at St. Michael's Hospital. "Unless all the criteria are met, an alert will come up and the nurse will not deliver the drug."

Hospital administrators say an electronic system will eventually result in savings by improving efficiency. Unlike Ontario's eHealth, which was embroiled in a multimillion-dollar spending scandal and failed to achieve its goal of supplying everyone in the province with an electronic health record - hospitals are moving their records online with money out of their own budgets. Since 2003, St. Michael's has spent about $46-million on implementing the technology.

"This is an example of e-health at work and which every hospital is trying to achieve," Ms. Trafford said. "But of course, the larger project is eventually having access to all records across the province."

So far, Dr. Michael Freeman, a cardiologist at St. Michael's explained, an individual hospital's records are limited in their connectivity to family doctors and local pharmacies.

"When a patient is discharged, we will provide an electronic letter to the family doctor, a letter to the patient with next steps … and a typed out letter to the pharmacy," Dr. Freeman said. Those healthcare practitioners would not be able to directly update the patient's record so that they are in sync with St. Michael's records.

In British Columbia, South Okanagan General Hospital has also started moving towards paperless patient records. Toronto's North York General Hospital has a similar eCare program in place in nine in-patient wards, including critical care, said Dr. Jeremy Theal, director medical informatics.

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Since 2008, the Ontario Hospital Association has been working in partnership with a U.S.-based not-for-profit Healthcare Information Management and Systems Society (HIMSS) Analytics group to track the progress of hospitals in the province in their bid to get records online.

St. Michael's, North York General and South Okanagan have all achieved Stage 6 status, which means a significant portion of hospital records are electronic. As of yet, no Canadian hospital is meeting the highest standard of Stage 7, where all records are electronic. In the United States, 55 hospitals have such a designation, including the Mayo Clinic in Rochester, Minn., and the Children's Hospital in Boston.

Dr. Theal said achieving Stage 7 is a "tall order." While U.S. hospitals are given financial incentives to move to a virtual health records system, hospitals in Canada "have to prioritize and do it on our own budget" without much help from the provincial or federal governments, he said.

But OHA president and CEO Tom Closson said Stage 7 is an attainable goal for the three Canadian hospitals.

"It seems that they are well on their way," he said. "Achieving Stage 6 of the HIMSS Analytics EMR Adoption Model demonstrates remarkable progress and dedication by a health care organization."

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