Lag in electronic health records is inexcusable

12 Mar

electronic-health-records-smallLast summer, I decided to switch doctors. My existing physician was getting a little long in the tooth and my visits to him were taking longer and longer, at times hitting two hours for routine issues like a cough. On some occasions, I’d sit across the desk from him wondering if he’d nodded off.

After asking around for recommendations, I landed myself a new doctor. I’m with him now and I’m quite happy. Visits are short and to the point and so far, he seems to have cured whatever ailments I’ve come to him with.

During the transition, I got a letter in the mail from the old doctor’s office informing me that he required $47 to transfer my medical records to the new practitioner. Now, $47 isn’t a lot of money, but I took it as blatant extortion. There is perhaps nothing more personal than your own medical records, so to have someone ask for anything more than pocket change to cover photo-copying and mail costs is an outrage.

I was of half a mind to start a legal proceeding against the doctor since, in Ontario, the Personal Health Information Protection Act gives individuals the right to their own information. Privacy commissioners in this province and in Newfoundland have indeed ruled in favour of people who have been levied such excessive fees. The Newfoundland commissioner, for example, found that people should be charged no more than $25 for a record of up to 50 pages, with each additional page costing a maximum of 25 cents.

In the end, I decided that since I don’t really have any major health issues – knock on wood – I’d drop the issue and start from scratch with my new doctor. Hopefully, this won’t come back to haunt me.

The solution to the situation is mind-numbingly simple: electronic health records. If my old doctor had simply typed his notes into a computer each time I visited, transferring the data would have been as easy – and as cheap – as pressing “send.”

I wasn’t very surprised, then, to learn that it wasn’t just my ancient doctor – Canada in general is way behind in adopting electronic health records.

According to a new survey from technology services firm Accenture, only five per cent of Canadian doctors allow patients to have electronic access to their medical summary or chart. That’s the lowest percentage in the survey of 3,700 physicians in eight countries: Australia, Canada, England, France, Germany, Singapore, Spain and the United States. Only seven per cent of Canadian doctors give patients access to their own or family member’s test results on a secure website.

Moreover, “less than a third of physicians (29 percent) believe a patient should have full access to his or her own record, 57 percent believe patients should have limited access and 14 percent say patients should have no access.”

Sanjay Cherian, Accenture’s health industry lead in Canada, says the problem is two-fold: incorporating electronic records happens both from a bottom-up perspective, where individuals doctors are trying out new technologies, and from the top-down, with institutions motivating change. “Cultural differences” on these issues are the reason why Canada is behind other countries, he says.

Accenture sells products in this area so it’s important to take the results with a grain of salt, but the lag has otherwise been well documented.

Fortunately, some provinces in Canada are doing better than others. I spoke with Calgary physician John Fernandes last year and he said Alberta’s Netcare EHR was “the single best electronic health record system on the planet.” It does indeed seem to be getting a lot of use from patients in that province.

There’s little excuse for why a country that touts such a great health-care system is lagging in this area. It’s also unacceptable that some physicians are actually still opposed to giving patients access to their own information, or worse, charging for it.


Posted by on March 12, 2013 in health


6 responses to “Lag in electronic health records is inexcusable

  1. Marc Venot

    March 12, 2013 at 4:11 am

    Maybe you can suggest an app that should be the common denominator in this domain? That could be the base for asking the politicians to move.

  2. trixxiii

    March 12, 2013 at 11:49 am

    $47 is that all??? Mine told me i had to cough up $200. Now is was for about 25 yrs but isnt that their job? to keep our files? i said NO of course – how can anyone afford that and yes its extortion and hung up. they called me back and reduced it to $100 which i thought was then a bargain at the time, but now im thinking they tricked me into spending $100 instead of that $47. Then my son needed his and his cost $80. so seems like no rhyme or reason just a way to make money for fools to photocopy and us fools to buy back our own files. Definitely not right!!!! but does anyone care??? NO!

    • Peter Nowak

      March 12, 2013 at 2:35 pm

      $200?!? You’re right, that is completely ridiculous. If mine had been more like that, I probably would have taken legal action, if only to discourage such obvious extortion.

  3. Adrian

    March 12, 2013 at 2:36 pm

    This is one area I have a lot of familiarity with, being the sufferer of a chronic auto-immune disease, and it is an indication of problems not just in electronic medical care, but in medical care in general in Canada. Specifically, the problem that transferring ANYTHING about your medical care between provinces is a nightmare– which in a large geographical country, with a small population who often have to travel for work/school/family, etc… is very problematic, especially to a sick person. I travel often between two provinces (Ontario being one of them), and getting even simple bloodwork in a province requires that I go to a doctor in that province, and get them to copy the requisition my doctor elsewhere already filled out. That is the least annoying problem. Healthcare as a provincial domain is really problematic, and should either be federalized and brought into an electronic future, OR, has to have a standard applied that allows for interchangeable prescriptions, requisition forms, and as you so rightly pointed out Peter, our own patient records.

    On a side-note: dealing with personal illness lapses for over a decade, and that of one of my parents as well, to get truly accurate and concise records, it is best to take somebody with you to your medical appointments. A friend, spouse, parent, or even child, who can record what prescriptions were given, what treatments discussed, and even what your weight and blood pressure are, is very helpful. It is hard for a sick person, in a lethargic state, with a doctor with low expectations, to take accurate notes– and even with access to your file, a sick person’s is MUCH larger and more chaotic, at least as a paper copy, than that of a fairly healthy person’s. Especially since accurate record-keeping can be vital in getting tax rebates, and other government considerations which are vital to someone who is disabled (temporarily or otherwise) by illness. But truly accurate, and efficient electronic records, that ideally allow space for patient commentary on each medical appointment, would completely solve that problem.

  4. Torontoworker

    March 12, 2013 at 7:40 pm

    The public don’t realize that the conversion of paper records (legacy) to electronic format is just one small part of the total E Health project. There are many different medical office management software packages that were sold to doctors through out the Province over the last dozen years by various firms that up until five years ago were not compatible with or easily converted into the format that has now been put in place by the Province. One of the main goals of this project (aside from the efficiencies that electronic record keeping will bring to the system) is the ability to match the actual patient billings sent to OHIP against the procedures as recorded in the patients records. Up until the last few years – auditing of medical billings was a time consuming expensive process that resulted in fewer then 5% of all billings cross checked to actual service provided. The future hopes (20 years est) are that ALL patient records will be recorded to MOH servers instead of remaining locally with your doctor. You can understand that *some* in the medical profession would see such developments as interference in their profession and are pushing back…

  5. Dave

    March 19, 2013 at 9:49 am

    Your article is wildly off the mark. Do you know that 10,000+ doctors in Ontario currently use an electronic medical record (including over 60% of family physicians)? That’s more than all other provinces combined.

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