If you asked the average physician whether it was more important to be able to communicate with hospitals or physicians within the community to whom they refer patients, my guess is that the vast majority would choose physician-to-physician communication. The most recent podcast published on CanadianEMR was a frank discussion with Dr. Mark Dermer entitled Should Physicians be Forced to Adopt EMRs? In this podcast, Dr. Dermer makes the point that physician-to-physician communication has never been part of the national IT strategy. This is evidenced by the fact that EMR-to-EMR interoperability standards have never been clearly defined. This critical limitation is reducing growth of the market and adoption of EMRs.
Why is it so important? Most community-based physicians (where 80% of the care is delivered) spend a significant part of their day referring patients or responding to consultation requests. As a result, even with the best EMRs currently available, these referrals are created digitally and either printed or faxed to the receiving physician's office. There they are printed or received as fax/scanned documents into the EMR (if one is used) and when a report is created, the whole process is repeated as these reports are digitized, printed, and transmitted all over again. What a waste of time and energy.
How could we have missed this fundamental requirement for an EMR? The ability for providers of care to communicate and collaborate with one another!
Some may argue that it is too complex having EMRs communicating with one another directly through point-to-point communication. In this regard, I agree. However, there are many intermediary third-party information exchange providers who specialize in taking data from one system and translating it into a format that can be received by any other system to which it connects. These information exchanges are widely available and in each U.S. state are being deployed to handle exactly these issues.
Physicians communicate with and refer to a wide number of clinicians and ancillary care providers. An information exchange should be able to handle all of these communications needs and options. Perhaps at the beginning, a smaller number of connections are provided, but over time the use of the information exchange needs to become ubiquitous such that sharing of information is not an issue.
We should limit the development of proprietary provincial information exchange capabilities in favour of universal messaging standards that allow vendors of EMRs to build once and use many times. One can only hope that common sense prevails.
To add your thoughts or feedback, click on the “Comments” link below.