MAY 15, 2007
VOLUME 4 NO. 9

POLICY & POLITICS

BC launches province-wide EHR

System links up MDs across jurisdictions


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."

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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