BC-wide Electronic Health Record (EHR) still a pipe dream

Interoperability health records

The BC-wide EHR initiative to date is failing interoperability, costs are beyond original planned federal matching funds, no strategic plan started until 4 yrs & $150 million spent, and doctors were only consulted this past year. The government is finally ready to assess physician adoption but are at least three years away from having an interoperable system in place. Perhaps this helps explain why still only about 5% of physicians have actually fully adopted an Electronic Medical Record system. Yet, in my private little world, my current EMR solution achieves what I need it do on a daily basis. (Please see the two articles from the Vancouver Sun written by Vaughn Palmer that are linked in this article and also appear in the references below.)

Do we still think Electronic Medical Records (EMR) or Electronic Health Records (EHR) are the way of the future? Interoperability is the missing link that would make every physician jump on board but there is really no sign of this happening anytime soon. In the 16 years since I worked with David Pang, Luanna Bartholomew & David Campbell at Dartmouth Hitchcock Medical Center putting together our own EMR for ophthalmology, we have yet to crack the 5% mark of physicians who have fully embraced an electronic medical record. Of course the technology is there but politics, personal preferences for usability and other factors have continued to keep the dream of a world in which a patient can walk into any health facility and whomever they see can easily access health information to help care for them unattainable. When will we have interoperability and what is holding us back? Physicians are failing to buy stand alone EMR systems, even if they meet their current needs because they know the negative impact they will face in their transition and don’t want to have to later change to a system to make sure it will be interoperable.

Likelihood of EMR system interoperability

The goal was visionary and noble when the BC government proposed a province-wide electronic health record system. The federal government was to provide $110 million to match the provincial commitment with milestones along the way to receive the fed money. Well, great idea but they ended up spending $150 million dollars before even developing a strategic plan until the auditor general called them on their major oversight. Last year a handful of EMR systems were approved by the government for physicians based on a minimal set of standards. Unfortunately, none of these solutions are of any use to specialist physicians such as myself as there was no consultation with us in the approval process so they had no idea that there are certain features that we need that family doctors might not. For example, we need to be able to generate consult reports based on the history and physical findings back to the doctors who referred the patient to us. This is not something a family doctor needs to do and is not a feature of any of the approved EMR systems. The approach to interoperability adopted by the government - make sure none of the data is stored at the physicians office but rather on remote servers. Not one centralized server but just any server NOT located in the physician’s office. This was supposed to be more secure and allow access to the information from other locations such as hospitals, walk-in clinics, family doctors and specialist offices alike? How? By magic? None of the approved EMR systems talk to each other.

So here we are, more than $150 million dollars spent, agreement for federal matching funds of up to $110 million total toward a proposed $220 million cost and probably three more years until we see results. The matching funds program will run out and we will likely see at least another several hundred million in provincial money poured into this. At some point we will have approved stand-alone EMR systems but will these ever be talking with each other? The stand alone systems are very powerful. I am able to generate the consult letters that I want and even able to look up what medications my patients are getting from the provincial-wide database. The computer code is actually in place to allow e-Prescribing but the government won’t turn that part of the system on for privacy reasons so I print out a prescription at the end of a patient encounter that is otherwise completely paperless. Lab results automatically get imported to my patient’s chart but only if I requested those tests or another doctors requested that I get a copy. If they had a test elsewhere and I need the result to help care for the patient…no such luck. Like I said, the technology has existed for probably the past decade or more but too many different groups are involved to ever make this work. I don’t think even 3 more years is realistic; in my lifetime would even surprise me. Oh, what great forward thinking by our government. This must be keeping some people gainfully employed for decades to come.