EHR is as easy as shopping online

Patient records are just a click away thanks to Alberta's Electronic Health Record

By Jason Gondziola

Up until now, gathering information about unconscious or non-responsive patients was a virtual impossibility. Emergency-room physicians were left to rely on family members or MedicAlert bracelets, losing precious time while trying to hastily reconstruct a patient's history. A recent initiative from Alberta Health and Wellness is slowly changing that.

The Electronic Health Record (EHR), launched in October 2003, aims to arm Alberta doctors, pharmacists and lab technicians with up-to-date patient information, by consolidating patient data in a central repository for fast and easy access. The system's development was driven by a need to reduce the duplication of data throughout the province and to have patient information readily accessible during critical moments.

"The idea behind the provincial electronic health record is that no matter where you go in the province, emergency staff could pull up your electronic health record," says Christianne Dubnyk, a spokesperson for Alberta Health and Wellness. "It's just some key pieces of information. It's life-saving information, it's very targeted and it's not a patient's medical history."

Specifically, the record stores a patient's prescription history, allergies and laboratory test results online, allowing access only to qualified healthcare professionals.

"In the long run it probably will improve patient safety," says Dr Jim Kutsogiannis, assistant professor in Public Health Sciences and Critical Care Medicine at the University of Alberta. "I think it's a very good initiative from both the patient's point of view and the physician's."

The system comes at a cost of $59 million, including implementation up to spring 2004, and was developed in conjunction with IBM. Initial responses have been positive.

"We are a proponent and supporter of the electronic health record," says Greg Eberhart, Registrar of the Alberta College of Pharmacists. "We look forward to it as a means to provide timely information for health professionals to make decisions." He adds that although the pharmacy test sites have been using only one subcomponent of the system, it has been well received so far.

"The whole purpose is that it's supposed to support and improve the quality of patient care," said Darlene Schindel, a neurosurgical nursing coordinator with Neurosurgical Associates Limited, a group that includes all neurosurgeons in the Edmonton area. She said that the transition to electronic health systems has been complicated by the varied workforce in her field. "We're in a situation where we've got four generations of people who have different needs, different comfort levels and different expectations from their work, and that really affects how we work with information technology."

PROTECTING PRIVACY
According to Ms Dubnyk, the most important factor in the design of the EHR is the safety and security of patient information. She explained that security is ensured by preventing unauthorized access and by limiting use of the system by authorized users. Access requires a username and password, plus a dynamic key-code, which is transmitted to users via a key-chain sized device. A digital display shows authorized users the current dynamic password.

"The system monitors itself around the clock for unauthorized activity," says Ms Dubnyk. "The provincial electronic health record follows the highest electronic security in the world."

Transmitted data within the system is encrypted to prevent abuse by non-authorized individuals and high-quality network security is in place to prevent intrusion. Audit and log information is continuously collected. Authorized users who abuse the system can be tracked through system logs, and if found guilty are subject to fines of up to $50,000, as well as disciplinary measures within their licensing or professional organizations.

Ms Dubnyk was hesitant to comment specifically on the future of the EHR. "It's too early to say," she said. "But I think there are definitely other pieces of information that could come online. But the record was never intended to be a comprehensive medical history and it never will be, though there are areas that it will expand."

Although the system is now only in use at a limited number of sites, it is expected that one-third of physicians' offices and half of all pharmacies will be using EHRs by March 2004, with all remaining pharmacies online in the following year. The system is currently being used at a limited number of sites. In December 2003, the southern Alberta community of Drumheller became the first community in Canada to be fully linked to an EHR. Now over 15,000 patients in the community are being tracked using the online system.

"I'm pleased to see Drumheller's physicians are taking such an active role in implementing this life-saving tool in their community," says Dr Brendan Bunting, president of the Alberta Medical Association.

The provincial EHR is the sole electronic system in the Drumheller area. Other parts of the province are setting up complementary electronic health records, such as the Capital Health EHR in Edmonton, Alberta, which is currently in testing.