Patients to have full access
to eHealth records
BC health minister George Abbott
introduced new patient record legislation on April
19 to accommodate the new eHealth system. Included
is a change to the Pharmacy Operations and Drug
Scheduling Act that would authorize patients to
access their own electronic health records
a feature that's already being designed into the
forthcoming province-wide EHR system.
In addition, patients will be
able to check their EHR's access log the
record of who looked at their records and what
changes were made. Initially, patients will have
to request hard copies of their records and access
logs; eventually they'll be able to simply log
in via the internet.
"There is evidence of benefit
if patients are given information and the autonomy
to help with their own care," says Dr Burns. "So
giving them access to results, like giving a diabetic
access to hemoglobin A1c test results, can improve
their care."
But does this mean that patients
will be monitoring how often their doctors access
their records and confronting them about it? Not
likely, Dr Burns says. "As long as patients are
appropriately informed about what the audit trail
means, it should be fine."
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In a move touted by Ministry of
Health officials as the beginning of a new era for Canadian
e-healthcare, on April 17 British Columbia introduced
legislation to launch a province-wide, comprehensive
electronic health records (EHR) system. The plan
known collectively as eHealth includes a $148
million deal with software giant Sun Microsystems to
design and set up the tailor-made network.
"We're definitely going to be setting
a pretty high standard," says Paul Tier, a Ministry
of Health senior project director of the eHealth team.
"It really is going to be a new world of access to clinical
information."
The Sun Microsystems contract covers
two of the seven projects that make up eHealth: the
Provincial Laboratory Information Solution Project (PLIS),
which will centralize lab result reporting; and the
interoperable Electronic Health Record (iEHR), the structural
underpinning that will enable physicians to access the
various elements of the EHR and to communicate with
one another across different software platforms. The
iEHR portal will also include access to a number of
different medical databases such as the lab reports
database, electronic prescribing ability and patients'
electronic medical records (EMR).
BIG
BENEFITS
Dr Robert Burns, a senior medical advisor for Canada
Health Infoway who has been working with the BC government
on its eHealth plan, says doctors stand to benefit significantly
from PLIS and iEHR. "We can reduce test duplication
and adverse drug interactions," he says. "The short
answer is, for physicians and other providers, there
will be available all the appropriate information about
your patients at the time you're seeing them."
The Ministry of Health boasts that
although eHealth carries a hefty pricetag, the new contract
is actually very cost-effective. The ministry says it
will reduce duplication and eliminate inefficient paper-based
communications; savings on lab operating costs alone
could add up to $3 to 6 million per year.
HELP
FOR SPECIALISTS
Dr Alan Brookstone, a Vancouver physician who runs the
independent website CanadianEMR, says the implementation
of PLIS and iEHR will have a far greater impact on specialists
than on GPs. "For a GP who already has an EMR system
with interfaces from the key systems they work with
like the local hospital and lab, and the DI [diagnostic
imaging] systems coming in the future this won't
make a huge difference because they have everything
they need already," he explains. "But it will be incredibly
important for specialists, who often receive referrals
without all the information this will make it
much easier to look it up."
With so many patients resorting
to episodic care (ie, using walk-in clinics or emergency
departments) because they don't have a family physician,
accessing basic medical information about patients from
across the province is more important than ever, says
Dr Brookstone. "In those situations it will be invaluable
for GPs in emergency departments or urgent care centres
or walk-in clinics."
TIMES
ARE A-CHANGIN'
Introducing such a complex new structure can be intimidating,
admits Mr Tier, but he insists that it's a voluntary
system and the government is doing all it can to facilitate
the changeover. "We want to minimize the frequency of
change in the physician's office," he says. "The important
message is that although BC is introducing a lot of
changes, our philosophy is to do it once, do it right,
and minimize the change cycles happening at the point
of care."
Training will be provided to physicians
throughout the implementation process from basic
education about the system to computerizing records
and learning about privacy best practices through
a fund of approximately $110 million administered by
the Physician Information Technology Office, a joint
project between the provincial government and the British
Columbia Medical Association (BCMA). "It can't be underestimated
the amount of training and changes needed to automate
a physician's office," says Mr Tier. "The evidence indicates
the more time you spend on transition and change management,
the better the outcome." Mr Tier says BC's program will
be modelled on similar programs in Ontario and Alberta.
The fund also covers computer equipment
and software. That amount of money won't be enough to
cover all these things in the long run, says Dr Burns,
but it's important to provide physicians with some funding.
"For physicians, the initial capital outlay is a significant
barrier," explains Dr Burns, "and to mitigate that does
seem to have a positive effect on uptake." The only
catch is, docs will have to choose an EMR system from
a list provided by the province, but they'll be sure
their system is compatible with eHealth.
PRIVACY
MATTERS
Besides money and time, privacy is generally the next
biggest concern for doctors considering starting on
an EMR system. Dr Brookstone, who consults for the BC
Ministry of Health's working group on privacy, says
in many doctors' minds electronic records and security
violations are closely linked. "It creates more questions
of privacy, of stewardship of data from the perspective
of patients," he says.
But Mr Tier says electronic records
are actually much more secure than paper records. "When
we build these systems, we track all access to records
who did it, when, from where? This feature should
give physicians a sense of comfort that their patients'
information is being appropriately tracked and monitored
and audited."
"There is some work to do still
in engaging physicians in the process," says Dr Brookstone.
But overall he's optimistic about the eHealth system.
"I think it will be an excellent project. As with any
project of its size, there is a significant risk because
of complexity. But will it move BC towards an interoperable
electronic health record? Absolutely."
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