In 2000, it appeared that EMRs were poised for rapid adoption in Canada. Countries such as the UK, Denmark and New Zealand had already solved many of the challenges associated with computing in primary care with EMRs widely adopted and used by general practitioners. Over the past 10 years, this number has grown progressively reaching close to 100% in all of these countries. With a great deal of international experience to draw from and committed national and provincial funding EMRs should have been widely adopted. But this has not been the case.
Without a national approach to data communication standards for EMRs, ePrescribing and referrals and consultations, big gaps have remained that hinder the adoption and use of EMRs. Complicated by provincial certification requirements, specialist needs with respect to EMRs, the geographic diversity of Canada and a lack of widespread reliable high-speed connectivity to support ASP-based EMR systems, we have continued to see adoption in fits and starts. A growing number of practices and networks have begun to derive significant value from their EMRs, an example of which is the Associate Medical Centre in Taber, Alberta (Listen to the Podcast with Mike Brand and Audrey Wiebe).
I would like to make 5 predictions for the period 2011 - 2015. Please feel free to add your thoughts or comments to this blog whether you agree or disagree, or perhaps would like to add a prediction of your own.
Prediction 1: Canada will solve the problems associated with referral and consultation between EMRs. There are sufficient users of EMRs to justify a concerted national effort to establish national approaches and standards in order for information to begin flowing between GPs and Specialists and also between EMRs and other clinical sites. Success will depend on a national strategy that is supported by all provinces such that EMR vendors do not have to develop different referral protocols for each province
Prediction 2: We will continue to struggle with ePrescribing through EMRs. The lack of national acceptance of electronic signatures coupled with the absence of a national body overseeing ePrescribing (such as Surescripts in the US) will continue to hamper the widespread adoption and use of ePrescribing and medication reconciliation information. Provincial programs will continue to fragment the use of ePrescribing as systems are designed to meet the requirements of provincial systems vs. all systems meeting a single national ePrescribing standard.
Prediction 3: Use of tablet computers and smart phones to access and interact with EMRs will become widespread. The development of special apps to access specific components of EMRs (e.g. lab results, patient contact information) will make the smart phone a standard tools in the physician's use of EMRs and will significantly increase the value proposition of EMRs.
Prediction 4: Physicians will struggle with the growing prevalence of social networks and the challenge associated with maintaining personal and professional boundaries as Facebook and other social networking tools become the preferred mechanism for communication by many patients. Widespread use of social networking tools will require provincial licensing bodies to develop new policies and guidelines regarding the appropriate use of these tools.
Prediction 5: Without widespread and transparent quantitative satisfation data on the adoption and use of EMRs, selection and optimization of EMRs will remain difficult for physicians and their practice teams. The need to benchmark and measure one's progress against that of peers will either limit adoption and use (if these data are absent) or will significantly enhance the ability to guide EMR adoption and use.
Please feel free to agree or disagree with anything that I have said. Add your thoughts by clicking on the 'Comments' link below.