Changes in Digital Health-The Primary Care Medical Record

Welcome back to The Doctor Is In.  This blog is an opportunity for me to connect with Ontario’s doctors and Ontario’s patients about the issues that are important to them.  And today we are going to tackle one of the biggest pain points in our current healthcare system.  The interoperability of our electronic medical records (EMRs).  I know it doesn’t sound exciting, but it is.  This is one of the single biggest issues we face as physicians and patients in the healthcare system.

I recently needed to send a patient to the emergency department.  Her symptoms were severe and could not be managed in a family medicine clinic.  I printed off a letter to be given to the paramedics and then to be passed on to the emergency medicine physician at the hospital.  Why?  Because otherwise the paramedics and the hospital would not have a list of my patients most recent health concerns, medications, or allergies.  Where was the hospital she ended up being treated at?  Less than 3 km from my clinic.  

But there is limited connection between our systems.  When my patient arrived at the hospital, despite the information I had provided, there was confusion as to her reason for being in the hospital and she ended up receiving a medication that was not necessary.  Not because anyone didn’t do their job but because the system is not designed to support accurate and efficient patient care between care settings.  Thankfully we fixed this concern, but only because myself and the amazing hospital staff were being diligent.

This is only one example of a challenging and pervasive concern.  Patients rightly expect physicians to be able to access their health information.  And doctors want to be able to access the most recent health information for their patients.  But the system in Ontario is multiple silos of EMRs that do not easily speak to one another.

For the first time, we now have an opportunity for this to change.  The Ontario government recently announced significant funding for a new initiative—The Primary Care Medical Record (PCMR).  This will be the first time Ontario is funding the creation of EMRs which are specifically designed to talk to one another.  The goal is to ensure that physicians across the province can access health information when needed and that patients can reliably expect doctors in different clinical settings to have access to the records needed to facilitate this.  

I AM INCREDIBLY EXCITED BY THIS PROPOSAL.  This is what is needed to move our healthcare system forward—it will improve connection between hospital care and community care and between all of our specialties.  It will reduce the administrative time doctors spend chasing down records, it will support patients who need to move to different areas of the province, and it is only appropriate for our system to be catching up with the digital solutions we are seeing in other sectors.

Despite there being an overwhelming amount of support for this proposal, we also need to make sure that this is implemented as effectively as possible.  We have seen digital health solutions be implemented before where they end up decreasing efficiencies in medical offices because they were designed without physician user experience being considered.  For the PCMR to succeed in Ontario, doctors will need to be considered at every stage of development, ensuring that the product adds value and efficiency to medical practice in Ontario. 

And we need to ensure that we bring patients and physicians alongside us on this journey.  A change in how our EMRs talk to one another creates several new concerns for patients and doctors-patients may be concerned about their privacy-just what information will be available?  Physicians might be concerned about how the information will be used.  Family doctors are often the health information custodians of their patients’ records.  If this information is going to be available to others, what responsibility does the physician have in how others access and use the information? 

This means that along with co-design, there are other incredibly important principles that will need to be considered.  The first is patient education—patients need clear, plain text explanations of where and when their health information will be accessed and for what purpose.  The government will need to demonstrate to patients how their healthcare experience will be improved with this system.  Without buy-in from patients, this system will not work.

And along with this, a robust data governance framework will need to be designed.  Doctors will need to understand clearly what is and is not their responsibility in a system where information is interconnected.  And the incredible amount of hours and incredible amounts of money that physicians have invested to create their patients’ records will need to be recognized and considered in how this system is developed.  

And then the final principle which will be absolutely essential for this endeavour to succeed is to ensure appropriate change management resources are available across the province as this new product rolls out into the healthcare workforce.  It is not enough to have a product that works—you need a workforce and a patient population trained and prepared to use the product.  This will mean real supports will need to be available to physicians in Ontario to ensure that the implementation of the PCMR does not interrupt the delivery of patient care and does not further add administrative burden to an already burdened work force.

The OMA and our Section on General and Family Practice (SGFP) are proud to provide the physician perspective as the PCMR is developed in Ontario.  A set of recommendations have been developed to ensure we are clear about what is needed to succeed [1].  OntarioMD will play an essential role in this project and we are thrilled to have their expertise at the core of its development.  It is a massive undertaking but it has the potential to do more to connect care across the province than any other digital health solution we’ve developed in Ontario. The future of digital health is here.

[1] The Primary Care Medical Record System: Recommendations for Success from Family Physician Leaders