Within the next month, CanadianEMR will host the first of a regular series of round table audio forums dealing with topical issues that converge at the interfaces between the acute, community and primary care systems. The first roundtable is titled 'EHR vs. EMR - Issues and Challenges'. Two physicians and two CIOs from East and West will be joined by an industry analyst and will debate the challenges of convergence of EMR and EHR from the perspective of the business process and data management. Rather than a technical focus, the forums will be more targeted towards clinical issues relating to care delivery. Where are we currently and what needs to happen to see significant adoption and use of EHR and EMR in clical settings?
In preparation for the roundtable, I will be posting a number of preliminary discussions on the CanadianEMR Blog to elicit feedback from clinicians who are involved in delivery of care. If relevant, your feedback will be incorporated into the roundtable as topics for discussion.
The first question that I would like to pose for your thoughts and feedback relates to interoperability. It has been hard enough coming to agreement on the definition for an Electronic Health Record (EHR) and Electronic Medical Record (EMR), but I am not sure we have clearly defined Interoperability. I can see a future state in which all healthcare technology systems are able to share appropriate information electronically, and one can visit the Interoperability Showcase at the annual Canadian eHealth Conference to see some of these capabilities in action.
However, I think it is time for a reality check. We still have a system in which the majority of Canadian physicians function in a paper-based world. Less than 30% have adopted EMR systems in their practices and the number fully utilizing their EMRs beyond the level of electronic versions of paper charts is smaller yet. How can we talk interoperability when we don't yet have a critical mass of providers connected to the broader system?
We also have not designed our information technology systems to solve core business needs such as the ability for a system to send a referral to another provider and receive a consultation report - electronically - and with consistency. Or the ability to easily prescribe electronically directly from the EMR system to the pharmacy. Where are we in our policy work related to electronic signatures?
To talk about interoperability, we need clarity in terms of what exactly is interoperable? Is it everything or just certain data e.g. lab results? Is it from one EMR to another or between EMRs and EHRs? Is it an end-state or simply a new state in which we will function? One that will always be in a state of evolution.
Ontario, BC, Alberta, Nova Scotia, Saskatchewan and Manitoba have all gone down the path of conformance testing and approving EMRs in those provinces which will qualify for provincial funding. Will this guarantee interoperability?
Should we be looking more closely at Denmark and New Zealand and adopting a parallel strategy to EMR conformance testing that can solve some of the problems of interoperability? For example, if all EMRs had the ability to send a referral message and receive a consultation message according to an standard national message format, could we accelerate the process of adoption by more effectively meeting the business and clinical needs of providers?
I welcome your thoughts and comments. To add to this discussion, click on the 'Comments' link below.
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