the benefit of using the EMR flows to the system and not to the individual physician who is required to purchase and use them, according to Pinhas.
What often happens is government wants EMR to take care of things like increasing emergency visits and problems with drug interaction, which the physicians would agree with, but the individual benefit to the physician's office from a workflow standpoint has to be looked at, he said.
"Studies we've seen suggest that the system in general benefits about 70 per cent and the physician benefits about 30 per cent. The reason for that is the health information is captured at the point of care, which is in the physician's office. Most patient visits are done to the community physicians, so it's captured and then sent in an electronic format to all the other health-care providers that want to use it as well as for secondary use" like research, Forster said.
Interoperability
"Some physicians won't proceed forward with an EMR unless their hospital is going to transmit all the data stored in the hospital system. But for a hospital to actually send out the data, they need a fairly expensive interface," said Pinhas.
A number of systems don't communicate with each other and there are a number of standards that exist but haven't been adopted, he said. Doctors are not willing to use an EMR if 60 to 70 per cent of the information they receive is still on paper.
"There are a lot of chicken-and-egg problems," said Pinhas.
More than 90 per cent of physicians are using EMR to write and renew prescriptions, which is a huge benefit because it does drug-to-drug interaction and allergy checking, Forster noted. But hospital discharge summaries, consultations, requests and reports among physicians are for the most part still paper-based, he said.
Efforts are underway to change this. OntarioMD is currently working with RVH and the Barrie Family Health Team to define an interface, which will provide more value as they plan to implement further abroad later this year, and two EMR projects being used for early adopter prescribing are taking place at Sault Ste. Marie Group Health and the Georgian Bay Family Health Stream, he pointed out.
"If you take a look at other countries, the physicians have adopted it more because they do get hospital discharge, they are able to get the lab results -- which is what OLIS is -- they are able to do referrals and they are also able to do electronic prescribing completely as well. We have a lot of the benefit of the prescribing, but it doesn't fully get delivered to pharmacies today," said Forster.
The Ontario Lab Information System (OLIS) is one example of a large-scale project that has tremendous benefit to physicians who use EMR, but the project is several years behind schedule, Pinhas pointed out.
OLIS would allow physicians access to all patient lab data, regardless of which lab did the work and whether it occurred in a hospital or public lab, whereas right now, they have to establish a one-on-one relationship with each individual lab in order to get the data transmitted, Pinhas explained.
"Expediting [OLIS] would say to a physician, 'Now my external data is all coming to me electronically. I really need to get going on this computer thing,'" he said.
McLaren's group heard about OLIS years before they implemented EMR in the 90s. But more than a decade later, there's still no deliverable on the project to EMRs in the community, he said.
"In the last few years, they've been accepting labs from hospitals and from private labs and making a central repository, but it's not a functional interface down to EMR, so that many people who do implement their EMR have a real difficult time actually getting electronic lab data to flow into the EMR," said McLaren.
Selecting the right EMR system
Another major obstacle, according to McLaren, is choosing the right EMR system. This requires defining needs, what problems
Post new comment