One of the gaps in provincial and national EMR strategies is the ability to move information seamlessly between different providers in the healthcare system. This includes primary care physicians and specialists and the myriad of additional care providers that are integral to high quality comprehensive care. With EMR adoption growing across the country, we are nearing a critical mass in some provinces — at which point it will become a requirement to be able to manage referrals and consultation reports electronically.
Physicians are primarily information exchangers. The transmission of referrals and the ability to electronically send a consultation report back to the referring provider should be a core foundational requirement of all EMRs. In a healthcare system that places the patient at the centre, no patient should be penalized because their doctor uses an EMR system that is unable to send or receive electronic referrals or consultations.
Canada Health Infoway provides a pre-implementation certification program for EMR systems that incorporates interoperability standards for labs, drugs, and clinical reports. Interoperability refers to the ability for information to be transmitted between systems in a standardized format that maintains the integrity of the message. This means that information sent from one system is presented accurately in the receiving system. According to the Infoway Certified Products list, six EMR systems have achieved certification. Three products are provincially certified and three have received national certification. All of these certifications expire in June or December 2013. There are a significantly greater number of EMR products available in Canada that are provincially certified under provincial EMR programs. Only one of the four BC provincially certified EMR systems (Med Access) has received Infoway certification. However, in order to be successful, two requirements must be met. All EMRs need to have equivalent certifications and those certifications must be well adopted in order for data to be effectively shared. BC, as well as other jurisdictions, has implemented provincial certifications for EMRs that include interoperability requirements.
A number of pilot projects to evaluate referral and consultation are underway in different Canadian jurisdictions; however, we need more active testing and implementation of EMR to EMR and provider to provider exchange of information. This is no simple undertaking, but it can be done. Denmark and New Zealand have been successful with their data interoperability programs. These are smaller countries than Canada both in terms of population and geography, but the lessons learned are equally applicable.
Electronic Referrals are a key starting point in the appropriate sharing of clinical information amongst care providers. But it is not enough to just enable this capability with the belief that the job is done. Until physicians have EMRs that are fully interoperable with other providers’ systems, they will be forced to function as hybrid practices managing some processes using paper and others electronically. This is inefficient, prone to error due to the need for duplicate processes and reduces the value proposition of an EMR, particularly to those clinicians who just want to manage their patients and are less interested in the technology.
There is a lot of work to be done. It is good that we are testing eReferral processes, but much more is needed.
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