Canadian physicians want to use more online tools to consult with their patients, but they say there are obstacles. And one of those obstacles is remuneration.
“In Canada and in the U.S., physicians don’t get reimbursed for a secure e-mail exchange, and time is money for physicians. If they can’t get reimbursed, they have less incentive,” says Frances Dare, a director with Cisco’s health care group.
This sentiment is echoed by Dr. Stephen Chris, a former Toronto-based family physician, who says the process of deploying IT for physicians is both expensive and time-consuming.
Ontario MD manages a fund established by the Government of Ontario to promote the use of IT, in particular electronic medical records and secure e-mail communications for physicians, says Chris.
“We subsidize family physicians who are purchasing approved electronic medical record systems, or what we call CMS (clinical management systems),” he says. “We validate the vendors, make sure their products meet minimum specifications, and give assistance to physicians in the process of implementing electronic medical records.”
He adds that Ontario MD had enough money to subsidize just over 500 doctors, but they received over 2,000 applications.
“There’s a tremendous appetite in the family physician community to move to an electronic medical record environment, but its expensive and very time-consuming to establish what you need and get it installed,” says Chris.
And it would appear that patients are also hungry for this electronic interaction. A recent U.S. survey showed that consumers would like to see their doctors embrace online tools within their practice.
A key finding of the survey was that patients would like to see this happen in three main areas: directly e-mailing their doctor, accessing lab results online via a secure Web site and scheduling appointments online.
The survey, conducted by Illuminas for Cisco’s health care division, was based on the responses of over 4,000 participants. “We were interested in how a relatively healthy population can be well served by health care services that are provided online,” explains Dare.
“It becomes clear, when you examine these findings, that consumers are very much interested in health information online,” she says. “People aren’t just going out as curiosity seekers; they actually are making decisions based on what they find.”
Dare cites Grand River Hospital in Kitchener, Ont., as a leading Canadian example of providing health care information online. Grand River Hospital has built a portal dubbed My Care Source , used by patients managing cancer, and plans to launch another for patients with chronic kidney disease.
The Cisco executive says that while hospitals and health systems such as those at Grand River have been reaching out to consumers, physicians have not.
“I don’t think anyone in the industry has felt that the primary care physicians needed to carry that banner,” says Dare. “Hospitals typically have bigger budgets, more people resources to manage IT and all of the things that make that more doable.”
“We haven’t had a lot of deployments in Canada, but there’s evidence that suggests being able to empower patients, getting them to engage in their self-management, can really improve their outcome and sense of wellbeing,” says Muttitt.
Muttitt adds that Infoway is building the new kidney disease care portal on the success of Grand River’s portal for patients managing cancer.
“The portals allow patients to be more engaged in their care management. They’re able to monitor their processes and keep a journal of their side effects,” says Muttitt.
“This helps to facilitate better communication with their health team and improves intervention. It also prevents some of the progression of the disease, and that’s really what’s pivotal here.”
The urgency for physicians to move to an online care environment is growing internationally, according to Dare. “What I often see as I work across Commonwealth countries and the U.S. is that physicians, especially GPs, are feeling a huge pressure to implement a full electronic medical record in their practice,” she says.
Dare concurs with Chris that implementation is expensive, however. It’s also a massive undertaking in terms of the technology involved, she adds, as it also changes physician workflows.
“I think the more we in the IT industry and the rest of health care can help physicians find some good first steps, that aren’t quite so enormous, it starts us down that path in a very tangible way.”
Key findings of the survey:
– 45 per cent of Americans said they would like to be able to directly e-mail their doctor
“It will develop (in Canada) because it’s efficient for patients and for doctors. But it’s only efficient if you get paid for it,” says Chris. “That’s something we’re a bit behind on: developing remuneration systems consistently with modern electronic health systems.”
– 34 per cent said they would like to access lab results via a secure Web site
“For young people, computers and the Internet are a part of their lives,” he says. “So we’re going to have to develop, and are in the process of developing in various places, systems by which a patient electronic health record can exist.”
– 33 per cent said they would like to book appointments online
“I think there’s a role for online booking and, although it seems pretty simple, I think all of us (both patients and physicians) will need to get comfortable with electronic health in other ways first.”