May 2017

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« Scanning Documents into an EMR and Paper Chart Storage | Main | Top 10 Benefits of Medical Practice Automation »


Greg Siren MD

I am a family physician in Victoria, BC that has refined a dry needling technique for the release of chronic muscle pain.

I am opening a referral clinic in early 2010 to provide this therapy. The service delivery model incorporates the use of technology to minimize physician and Medical Office Assistant documentation time.

A component of the patient process model will be the use of a patient portal to allow patients to enter into their medical record either online or on a waiting room computer:

+ identification information
+ a medical history including current medications, allergies, past medical and surgical history, social history and family history
+ a pain history
+ answer questions that are specifically relevant to potential risks associated with the treatment procedure
+ complete a treatment consent form, acknowledgement of audio and video recording of treatment and other medicolegal releases

Initial access to the EMR portal will be established through provision of an appropriately secure login and password generated by my office and provided to the patient by email or phone.

I understand that the Physician Information Technology Office (PITO) at the BC Ministry of Health has security and privacy concerns about patient access to an EMR medical record. The PITO subsidized EMR program being used in BC requires use of a Tier 3 server through a PPN.

I can foresee that there is a high likelihood that PITO will not want to risk potential compromise of their servers by providing patients restricted access and that I will have to implement a self funded standalone secure network if I want the functionality of a patient portal in my service delivery model. Should PITO make this decision, the use of patient portals by BC physicians will be very limited.

Your more knowledgeable and expert comments on the implementation that I plan would be appreciated.



Alan Brookstone for Eric Gombrich

The following questions are submitted by Eric Gombrich - CEO of EMIS Canada and are published on his behalf:

Given the growing body of evidence that PHRs do add value clinically, to both patients and providers, what are the goals for the PHR in Canada? Or is this yet another technology leading a problem scenario?

Given that we have very little clinical adoption of EMRs across the country, where is the data to populate the PHR to come from? If from the patients themselves, how ‘reliable’ will the data be, and therefore, how useful will practitioners find it/them?

Conversely, if we simply ‘push’ the data from those EMRs which are in place into the PHR, how is that to work given that there is virtually no standardization of data. Specifically and by way of example:

- A BP taken by a family MD using a cuff is vastly different than an arterial BP taken in the ER during a cardiac episode. Yet the vast majority of EMRs in Canada will equally record the findings as ‘BP’ without differentiating. How can the PHR manage this? Or are we to undertake a massively bureaucratic process of defining specific data elements to populate (and correspondingly, be excluded from) the PHR? Or will we instead invests millions of $ to build more ‘adapters’ to overcome this?

- If we consider use of automated devices operating under Class 2 and Class 3 regulations as self-calibrating, etc. will the EMRs / PHRs similarly take into account the ‘normalization’ of data and tracking of device information? For example, if a diabetic is using a glucose monitor, will the EMR / PHR keep track of the monitor’s information so that the data can be ‘normalized’ or will it assume all readings operate from a common baseline (they don’t).

Is the infrastructure in place to recognize that not all patients are equally ready for the same access to information?

A patient undergoing chemo for a confirmed lymphoma may want, and their physician may agree to allow them, to see the latest biopsy findings. However, the MD for a patient who is highly volatile with an undefined mass may not want that patient to see the biopsy results. How are we to control this? Is it through the PHR or the EMR? If through the EMR, how does the EMR control the PHR if they are not linked at this level of security / operational construct? And if through the PHR, will the PHR now have to authenticate the MD against the (nonexistent) provider registries?

Led by CHI, we started the interoperable journey by focusing on acute care data stemming from hospitals / ERs. The reality has now struck that the majority of data (~80%) is in primary care, and then to harness that, we need EMRs. But we are woefully behind there. Is the PHR energy not merely another way to avoid dealing with this significant shortcoming in the Canadian healthcare IT landscape? In other words, are we not focusing attention on ‘bookends’ and avoiding the books; we have the hospital data, we have the patients involved, we just don’t have the 80% in the middle that will make it all work?

Nancy Gabor

Thanks Allan, for the opportunity to post a question.

Understanding that physicians assume liability in terms of information listed in their EMR, sharing EMR data with patients poses a risk to physicians if that information is misunderstood and acted upon inappropriately.

It has been said that if physicians are forced to share EMR information with patients (via their PHR or otherwise, they are likely to document less information, or keep a separate record for internal use. Please comment on the issue of liability with regards to sharing EMR data with patients, and what you see as an appropriate solution to this issue.

Michael Martineau

- According a recent Deloitte Canada survey, "Almost two-thirds (61%) of Canadians want their physicians, hospitals and/or the government to provide them with a personal health record (PHR) or online medical records, and two-thirds (66%) would like to access a family member’s PHR." Given this strong level of interest, how fast should the Canadian health system move on providing patients with access to their own personal health information?

- Should PHRs / access to personal health information be provided at no charge to patients / consumers or is there an opportunity to recover costs through user fees? We currently charge for paper copies of personal health records so there is an argument to be made for some form of user fees for electronic access to personal health information.

- What is the role of the private sector in providing PHRs? Is there an opportunity to leverage private sector investments in other consumer on-line applications and understanding how to market on-line services to consumers?

- Question for Dr. Cavoukian - what rights do patients have to access their own personal health data (in whatever format)? If this data is stored electronically do they have a right to request an electronic copy or electronic access? Could a private company providing a PHR service request access to a patient's personal health information (in whatever format) if authorized to do so by the patient?

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