Roughly 30 per cent of family physicians in Ontario utilize electronic medical records (EMRs), according to OntarioMD Inc., a subsidiary of the Ontario Medical Association (OMA) funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC).
OntarioMD recently completed phase one of its Physician IT project, which provided EMR funding to 3,000 out of an estimated 10,500 family practitioners in Ontario.
“It’s about 30 per cent,” said OntarioMD CEO Brian Forster. About four million Ontarians would be covered by those emergency medical records, which is approximately 25 per cent of patients, because roughly one million patients in Ontario don’t have family physicians, he explained.
Despite recent funding scandals related to eHealth programs in Ontario, OntarioMD exceeded its target for the $150 million it received in government funding, noted Forster.
“The initial program we’ve executed over the last four years had a limited amount of funding. That funding was actually targeted at 2,900 physicians, but we were able to fund 3,000 because of the way we were able to optimize what we’ve done during those four years,” he said.
OntarioMD is currently in discussions with eHealth Ontario, which is now responsible for a number initiatives from the Ontario Ministry of Health and Long-Term Care, for funding that will support the next phase of the program over the next three years.
Under the old program, which expired in August 2008, physicians were eligible for a maximum $28,600 to implement an EMR system. “The new number hasn’t been finalized at this point and once it has, which we are hoping will be shortly, it will be announced,” said Forster.
But there are still obstacles to widespread adoption.
Cost and funding
Cost is still the major obstacle to EMR adoption for physicians, according to Dr. Stephen McLaren, a family physician based in Markham who belongs to an 18-physician group that began developing an EMR system in 1998.
The funding that was sent out was only partial, he pointed out. “It does not completely pay or continue to pay for what you need to do, so it’s nice to receive that partial funding, but I don’t think we should mix it up with it being complete funding because it’s not,” said McLaren.
Physicians looking at EMR realize there are a lot of costs outside the funding envelope, so they are going to have to make a business case for it, he said. “For some people, they find it a difficult business case to make, although in our case, we live the value of EMR and it has been a very good investment for us,” he said.
Another problem lies within the old funding model itself, according to McLaren, because it went to two different styles of practice and physicians had to align their offices with a payment scheme in order to receive the funding.
“So there’s two change management pieces that happen at once," he said. "I’m not sure if in the second round of funding they will remove that obstacle or not,” he said.
Limiting funding to family physicians has contributed to interoperability problems, such as a lack of intercommunication between family practices and specialists, according to Moshe Pinhas, president of Toronto-based clinical management system software provider P&P Data Systems Inc.
“The funding should be more uniformly distributed to those who want to implement it as opposed to practice or specialty … we don’t have funding in the province, for example, for specialists so specialists aren’t automating it at the same rate as the family physicians,” he said.
But Forster suggested looking at the objectives behind the funding.
“By 2015, they wanted Ontarians to have electronic medical records. The whole premise of the initial phase of the program was to target family health teams who are working with large bases of patients. If we get the family physician automated first, we then get records for all the patients electronically and then when we start to hook the specialist up, we’ve got the record that the GP then refers to them,” he said.
OntarioMD doesn’t expect this limitation will exist in the next phase of the program.
“The first phase was really just to prove the investment was a sound one, which I think we can definitely demonstrate because of the survey we did last year. As well, there are solutions other than just EMRs that are quite appropriate and are very suitable to specialists as well, so they may not need an EMR per say, although they need an electronic tool in order to exchange the information between the GP and the specialist,” said Forster.
Workflow and training
While funding is a barrier to EMR adoption for physicians in Ontario, Forster said another large obstacle is the change to the way they practice.
“Physicians use paper records at this point. Changing to electronic medical records means there is an impact to the workflow in their office, so reengineering that workflow is a key aspect of the functionality of the EMR,” he said.
OntarioMD is working on improving the circuit deployment so physicians can get the EMR up and running faster as well as training physicians on how to use them productively, he noted.
Part of OntarioMD’s Transition Support Program is the Peer-to-Peer Network, which was established by Canada Health Infoway and OntarioMD along with the Ministry of Health and Long-Term Care to connect physicians with colleagues to support their adoption of EMRs.
“The network is composed of peer leaders who are physicians experienced in using electronic medical records to improve practice efficiency and patient care. Peer leaders are mentors who support their physician colleagues in selecting and implementing an EMR system,” said Canada Health Infoway.
The Transition Support Program and Peer-to-Peer Network are very good projects, according to McLaren. “But the person still has to roll up their sleeves and do the end work as far as implementing … there’s a fair bit of work there and as you know work means you’ve got to devote some time, and getting time from physicians is a real challenge,” he said.
Providing incentives for physicians to use EMR systems is a critical part of the process, according to Pinhas. “The question has always been whether or not doctors view EMR as having a reward or not,” he said.
Another major obstacle, according to Pinhas, is that doctors don’t realize the workflow benefits. Electronic systems eliminate errors and call backs from the pharmacists, for example, which reduces the interruptions in the day of the physician, he pointed out.
“Physicians are by and large in the business of p