1 2010 National Physician Survey : Family Physician Usage of Electronic Medical Records Inese Grava-Gubins, Artem Safarov, Jonas Eriksson College of Family Physicians of Canada CAHSPR, Montreal, May 2012
2 Data Collection The National Physician Survey (NPS) conducted every three years Joint study by CFPC, CMA and Royal College has been supported by CIHI Largest Canadian physician workforce survey Sent to every physician, medical student and resident in Canada 90,079 recipients in 2010 Response rate in 2010: 18% 12,076 physicians 2,546 residents 3,139 medical students NPS data is weighted on several demographic variables to reliably represent the total population of Canadian physicians.
3 Electronic Medical Records Summary Health technology systems enhance physicians perceptions of their preparation for managing patients, increase their ability to document and follow up on adverse events, and improve the implementation of clinical practice guidelines 1. Previous studies indicated that, due to concerns over cost, security, privacy, workload and design, slow electronic medical record (EMR) uptake in Canada has placed it behind other countries in the adoption of this new technology 2,3. However, recent studies show that physicians in Canada are gaining confidence in the use of EMRs for improving the quality of patient care and practice management 4. This study looked at strategies implemented for the introduction of EMRs in various Canadian provinces, and the use of electronic medical records by FP/GPs, according to the NPS 2010 data.
4 Electronic Medical Records Summary Proportion of FP/GPs in Canada using electronic medical records to enter and retrieve patient information has been rising steadily. Percentage of FP/GPs in Canada using electronic records 16% Exclusive reliance on paper charts decreased from 63% in 2007, to just in Record keeping system for FP/GPs in Canada in 2010 In % of Family Medicine residents expected to be using electronic medical records upon entering practice. N/A or No response Exclusively paper Exclusively electronic 22% Mix of paper and electronic 28%
5 Provincial Differences Percentage of FP/GPs using electronic medical records by province 33% 25% 43% 26% 21% 51% 35% 37% 57% 46% NL PE NS NB QC ON MB SK AB BC CAN Territories data not available due to low sample size Despite the overall upward trend in adoption of EMRs, there are significant differences in use of EMRs between the provinces. Provincial regulations and funding support for adopting EMRs into practice have been introduced. The provinces were separated into several groups to highlight the existing policies and programs and the level of EMR implementation in each province.
6 Alberta Percentage of FP/GPs using electronic records AB Canada 57% 47% 27% 16% Record keeping system in 2010 Exclusively electronic Mix of paper and electronic Exclusively paper N/A or No response AB 38% 2 23% 10% Alberta s Physician Office System Program (POSP) has been in effect since 2001, offering physicians a 70% refund on costs associated with electronic medical records introduction. The program has been in effect throughout the past 11 years. Alberta has been a consistent leader in implementation and use of both EMRs and other medicine information technology tools, such as scheduling systems, laboratory and pharmacy interfaces etc. Canada 22% 28% In Alberta, number of FP/GPs using EMRs exclusively has consistently been the highest in Canada.
7 Ontario and British Columbia 18% Percentage of FP/GPs using electronic medical records 16% 16% ON BC Canada 26% 27% 51% 46% Record keeping system in 2010 Exclusively electronic Exclusively paper Mix of paper and electronic N/A or No response As part of ehealth Ontario s strategy of introducing electronic tools into healthcare, the OntarioMD program has been in effect since 2008, offering significant subsidies for physicians who wish to either adopt or upgrade EMRs being used in their practice. It also offers a free EMR transition support system. British Columbia introduced the Physician Information Technology Office (PITO) in Up to 70% of physician costs for EMR implementation are covered. BC ON 2 30% 2 33% 33% 13% The use of EMRs in both Ontario and British Columbia has increased from 2004 to 2007 to 2010, as compared to the national average. Canada 22% 28%
8 Atlantic Provinces 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Percentage of FP/GPs using electronic medical records NL PE NS NB CAN NL PE NS NB CAN NL PE NS NB CAN Record keeping system in 2010 Nova Scotia s Secure Health Access Record (SHARE) has been in development since It was implemented in 2010 as one of several electronic tools being gradually introduced. EMR usage has been climbing steadily. The PEI health record strategy was initiated in 2007 and launched in Practices using EMRs exclusively are almost non-existent - mixed models are more prevalent in PEI. Canada NB Exclusively electronic Exclusively paper 22% 28% 8% 27% Mix of paper and electronic N/A or No response 54% 11% New Brunswick s interoperable electronic health record system (iehr) was initiated in 2007 and was still being implemented in NS PE NL 3% 12% 25% 42% 35% 30% 38% 34% 43% 11% 17% 10% Newfoundland is also in the process of developing of a standardized electronic medical record, with some other electronic tools already having been launched.
9 Saskatchewan and Manitoba 23% Percentage of FP/GPs using electronic medical records 11% 16% MB SK Canada 28% 21% 35% 37% Manitoba and Saskatchewan did not have a formal EMR strategy implemented as of 2010 data collection time. SK MB Record keeping system in 2010 Exclusively electronic Mix of paper and electronic Exclusively paper N/A or No response 20% 22% 43% 15% 17% 4 10% echart Manitoba and ehealth Saskatchewan were launched in Dec 2010, and Jan 2011 respectively, to provide financial reimbursements to the physicians who plan to implement electronic medical records in their practice. Canada 22% 28%
10 Quebec Percentage of FP/GPs using electronic medical records QC 16% Canada 21% Record keeping system in 2010 Exclusively electronic Exclusively paper Mix of paper and electronic N/A or No response FP/GP usage of EMRs in Quebec was below 10% in both 2004 and Although EMR use increased to 21% in 2010, Quebec remains the province with the lowest rates of EMR usage, and the highest in exclusive use of paper records to store patient information. QC Canada 4% 22% 28% 63% The QHR (Quebec Health Records) is currently being implemented with the goal of being fully operational by 2015.
11 Usage of Electronic Medical Records Summary National EMR usage by FP/GPs has been increasing steadily. Number of practices depending on paper records only is decreasing. Provinces that have implemented comprehensive strategies (Alberta, Ontario, British Columbia) are showing a higher than national average use of electronic medical records and a lower dependence on paper. A variety of existing programs are being implemented in Atlantic Canada and Prairies. Data from the future iterations of National Physician Survey will be useful in measuring the EMR adoption across the provinces.
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13 References This presentation was created utilizing original data collected for the College of Family Physicians of Canada (CFPC), the Canadian Medical Association (CMA), and the Royal College of Physicians and Surgeons of Canada's (Royal College) National Physician Survey Database. The study was also supported by the Canadian Institute for Health Information and Health Canada. The study and all of the data contained therein are the copyright protected works of the CFPC, CMA, and Royal College and cannot be copied or reproduced in whole or in part without permission of the CFPC, CMA, Royal College. 1. Davis K, McEvoy Doty M, Shea K, Stremikis K. Health information technology and physician perceptions of quality of care and satisfaction. Health Policy 2009;90(2-3): Leatherman S, Sutherland K. Quality of healthcare in Canada: a chartbook. Ottawa, ON: Canadian Health Services Foundation; McGinn CA, Grenier S, Duplantie J, Shaw N, Sicotte C, Mathieu L, et al. Comparison of user groups perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med 2011;9: Webster PC. Ontario survey indicates increasing reliance on electronic medical records. CMAJ 2011;183(1):E54-5.