Are you one of the approximately 35% of Canadian primary care physicians who have not yet adopted an EMR? If so, now is a good time to begin thinking about the next 5–10 years in your practice and what it will mean if you do not have an EMR system. When I began talking and writing about EMRs over a decade ago, using electronic medical records was the exception rather than the rule. At that time, although EMRs were already widely adopted by primary care doctors in many other countries, Canada was still an outlier. This has changed. Canada is still behind most other developed countries in the adoption of EMR, but we are quickly catching up and those who continue to avoid implementing a system will have different challenges they will face by retaining paper charts in an increasingly electronic healthcare system.
I regularly talk with physicians at educational sessions and the major change that I have noticed has been a growing sense of inevitability that EMR is the future of medical practice. I have not met a single physician in the last couple of years who does not believe that the healthcare system of the future will be technology driven and supported. The remaining physicians who have not yet adopted an EMR fall into the late adopter category. Unlike early adopters who are excited by technology and would implement EMRs irrespective of whether financial incentives were available or not, the late adopters need clear evidence that the EMR will provide greater benefit than their existing processes and are not particularly interested in the technology alone.
You may fall into one of the following categories of physicians who are still undecided. A list of potential benefits are provided to help support your decision to adopt an EMR:
- I am too close to retirement: This is often quoted by physicians as a reason not to adopt an EMR. They do not want to go through the implementation process and see themselves completing their careers without the necessity to make this change. While there may be a benefit to retiring and placing one’s paper records in storage, there are responsibilities post-retirement in terms of custodianship of paper records. Although licensing bodies may vary slightly with respect to the storage of records, prepare yourself to be searching boxes of paper charts and sending those records via courier to new physicians (if your patients are lucky enough to find a new family doctor). Alternately you can take advantage of a number of services that offer chart storage services for practices and charge patients a fee to have their records scanned or sent to other physicians. There is another very good reason to consider implementing an EMR prior to retirement. The likelihood of being able to attract a physician to take over your practice and patients without an EMR is very small. There are very few physicians (particularly new graduates) who would want to join a paper-based medical practice in 2012.
- It is too expensive to implement an EMR: Currently funding is still available in a number of provinces to support physicians in their purchase of an EMR. The funding does not cover all of the costs of hardware and software, but does underwrite a significant part of the adoption expense. This funding is not going to be available indefinitely. As a result, you should consider taking advantage while it is still accessible. There are many benefits to implementing an EMR, particularly with respect to the management of patients with chronic disease. As provincial payments to physicians are increasingly directed towards improving outcomes and measuring quality of care, EMRs make this easier through automated recalls and reminders and the ability to generate chronic disease management templates that make the entire process easier and more efficient. Incentives to provide care for chronic disease patients can amply compensate for the ongoing cost of operating and maintaining an EMR.
- I am happy with my practice the way it is: Nothing stays the same forever. You may have refined your work processes so that your practice runs like a well-oiled machine and with minimal dependence on technology. However, the world around your practice is changing. As more information is transmitted and shared between physicians and other providers through electronic referrals and consultations or E-Prescribing, you will not be able to maintain your existing processes and will be forced at some point to make the change to EMR. Rather than this being forced upon you, it is better to plan the transition and ensure that it is least disruptive.
There are many other reasons why you should consider adopting an EMR and I will cover more of these in future articles. However, if you have recently been through EMR implementation and would like to share your experiences and what drove your decision making, please click on the “Comments” link below.