Ontario Plan for Electronic Health Records at Risk - Official Says

Strong statements by Doug Tessier, SVP of development and implementation for the agency responsible for implementing the government’s multibillion-dollar electronic health records (EHR) strategy. He touches on a number of points related to policy by the regulatory colleges, expansion of the program and even changes to the way that physicians are compensated related to 'required use' of EHRs.

Canadian Medical Association Journal: March 2, 2010 :The government must also do more to persuade health regulatory colleges to overhaul policies that impact on EHRs, Tessier argues. “Let’s put our arm around them and gently bring them into the 21st century. ... With the regulations, the legislation and the policy changes that government has to do, that’s not so gentle. That’s on the critical path. If they don’t do it, we’re blocked completely.” Tessier also argues that Ontario’s program to encourage physicians and other health care providers to utilize EHRs must be expanded. Under the program, the government absorbs 70% of costs associated with a physician’s move to EHRs. “But it only goes to 9600 [of 24 600] physicians.” Physicians should be required to use EHRs, including applications such as e-prescribing, and to that end, the government should make the use of EHRs a condition of payment for medical services rendered, Tessier says. Tessier also notes that Auditor General Jim McCarter correctly identified that implementing EHRs in Ontario has been complicated by a decision to build the broad information technology infrastructure before developing applications. As McCarter stated in his report, that situation might have been avoided “had there been an overall strategic plan driving the EHR initiative from the very beginning.”

CMAJ: Ontario’s plan for electronic health records is at risk, official says.

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Comments

[Karim Keshavjee]

Doug Tessier is correct. If we don't have participation of the colleges (both regulatory and certification) in enabling the use of EHRs, it will be a long time before we see them being used. EHRs will create opportunities for new workflows and new paradigms. It will be a shareable record that can be viewed by all care-givers regardless of where they practice, enabling smoother transitions for patients across multiple institutions. However, there are no current regulations for sharing information with 'future others'. We constantly share information with others, but only from one point to another --family doc to specialist, hospital to family doc. The EHR will enable everyone who cares for a patient to see every record that was generated for that patient, regardless of where it was generated. That's pretty ground-breaking.

But we need the medical profession to make recommendations on what the new ways of working should be. Those recommendations will not and cannot come from government or technology deployment organizations, such as ehealth Ontario.

However, ehealth Ontario does need to make the data flow. OLIS needs to start sending data to all physicians who have EMRs. OneMail needs to work for all physicians smoothly and effectively --not in the way it works today: like a clunky donkey.

As long as ehealth Ontario can't deliver, the colleges are not going to work on 'theoretical' futuristic workflow issues. They need real use cases of need that come from their constituencies about what the practical, on-the-ground issues are. That will come when doctors, nurses and pharmacists are using technologies that fit within current regulations and start demanding better regulations to facilitate information sharing and coordination across the continuum of care.