Health records

They can save lives, and although the up-front cost of implementation is significant, in the long run they can save money, too. Yet among developed countries, Canada is one of the slowest in putting electronic medical records to work.

"I think there's been a failure to recognize just how important it is," said Dr. Brian Day, president of the Canadian Medical Association. "And it's certainly costing a lot of money not to have information."

An electronic medical record is a computerized store of a patient's medical information.

The terms electronic health record (EHR) and electronic medical record (EMR) are often used interchangeably, but many in the medical field distinguish between them this way: EMR refers to a record kept in a single physician's office while an EHR is usually found in a hospital and is accessible by more than one practitioner.

But it's not quite that simple, because EMRs in doctors' offices can provide access to the shared information in EHRs, notes Richard Alvarez, president and chief executive of Canada Health Infoway, a non-profit organization set up by Canadian federal and provincial health ministers to promote the use of electronic health records.

A simpler way of thinking about an electronic health record is that it's a system that helps ensure anyone who deals with a patient has access to all the information about that patient.

That can be a lifesaver, Day says. He notes that 7.5 per cent of people admitted to hospital experience some kind of adverse effect while undergoing treatment. Many of these — caused by drug interactions, allergies and the like — could be prevented if information about the patient were more readily available, he said.

There are economic costs to not adopting electronic patient records, too. It's all too common that a specialist orders tests for a patient, not knowing that another specialist has already ordered the same tests. Making results available through an electronic health record could eliminate much of that duplication, Day said.

Poor track record

While Canada as a whole is behind much of the developing world when it comes to adopting EHRs, some provinces are doing well in implementing them, Alvarez notes.

But while we are making progress in EHRs, Alvarez says, "to get the benefit of the EHR we've got to start automating our doctors" to make sure the information is getting into EHRs in the first place and is being used.

In that respect, Canada's record is dismal.

According to a Commonwealth Fund study conducted in 2007, only 23 per cent of Canadian physicians use some form of electronic medical record. That compares to 98 per cent in the Netherlands, 92 per cent in New Zealand, 89 per cent in the U.K. and 79 per cent in Australia.

Canadians can take some comfort from the fact that our pitiful adoption rate of EMRs is matched by one other country in the study: the United States.

Canada is "leaps and bounds" ahead of the U.S. in this respect, Alvarez said, although we still fall far behind countries such as the United Kingdom.

The reasons for the poor performance in Canada and the U.S. differ as much as our respective health care systems. In the U.S., the low use of EMRs is attributed largely to the fragmentation of the system, Alvarez said. In Canada, both he and Day blame a lack of government attention to information technology in health care.

"I think there's been a failure to recognize just how important it is," Alvarez said.

Information technology has been "the poor cousin" in health-care funding in Canada, he said. Ottawa has provided $1.5 billion, which the provinces matched, for a total of $3 billion. But automating records in all doctors' offices, clinics, hospitals and labs across the country will cost about $10 billion, Alvarez said.

That sounds expensive, but according to Alvarez the savings resulting from that automation could run to between $6 and $7 billion annually.

Public support

Alvarez and Day are not alone in believing Canada needs more electronic health records. According to a public opinion survey conducted for Canada Health Infoway, Health Canada and the Office of the Privacy Commissioner of Canada in June and July, 87 per cent of Canadians believe electronic health records will mean quicker and more accurate diagnoses, and 82 per cent think they will reduce prescription errors.

The poll was based on interviews with 2,469 Canadians and is considered accurate within plus or minus two percentage points, 19 times out of 20.

Digitizing health records is the sort of project that costs time and money initially but pays dividends down the road, according to health-care workers like Michelle Greiver. The Toronto physician started converting her practice to electronic medical records in March 2006.

The conversion cost "six months and a really sore neck," said Greiver, who did most of the work of typing data from paper records into the system herself — whereas many physicians hire help to do this, she notes. She worked an extra hour or two per day for those months and estimates the value of the time she personally spent on the conversion at between $10,000 and $15,000. There was also staff time, and the necessary hardware and software ran to about $30,000.

Greiver received $28,000 in government funding to support the conversion — not quite enough to cover the capital costs — so given the time she put into the project it's easy to see why physicians aren't scrambling to go electronic.

At first, the electronic system was troublesome, Greiver said. "You're very wistful and you say 'Oh, this was much easier on paper.'"

But now, she says, the partner who shares her practice and still uses paper records spends more time in the office than she does. When the partner took time off recently and she covered for him, Greiver had the chance to compare the manual and electronic systems side by side.

"Having had to go back to paper for a week," she wrote on her blog, "I can unequivocally say that no, absolutely not, under no circumstances, and no way would I go back to paper. It doesn't work."