Dr. Gil Grimes says he was not “enamoured” with the idea of using paper charts.
When he worked at the O’Leary Health Centre, Grimes regularly kept important medical records of his patients on paper charts, instead of in an electronic medical record database. Grimes believes this practice, still common in P.E.I., resulted in inefficiencies and outright time wastage. A patient’s basic information would be repeatedly written down, handwriting of different physicians would have to be deciphered and records had to be physically filed.
Grimes relied on a staff nurse to keep records accurate and in order.
"The nurse was taking on a lot of work that wasn't really nursing but was really kind of chart management," Grimes said.
"Paper charts are a lot to manage. They take up a lot of physical space."
After moving to the West Prince Family Health Centre in 2013, Grimes decided to switch to using an electronic medical record (EMR) system. He chose OSCAR, an open-source system originally developed at McMaster University. The system, which can be accessed online remotely through a secure login, has allowed Grimes to share patient information with other health professionals.
"Because it's all within the electronic chart, none of it gets lost. I don't ever lose that little piece of paper, where somebody had left a sticky note that said, 'well next time you see him, do this,'" he said.
Grimes may be in the minority when it comes to P.E.I. physicians who have adopted an EMR system. A 2015 survey of 85 physicians conducted by the Medical Society of Prince Edward Island found that about 30 per cent used an EMR system. Of physicians Grimes knows in West Prince, four use an EMR, while three do not.
By comparison, the national average of EMR use was 85 per cent according to a 2017 study by the Canadian Medical Association.
In the midst of a shortage of physicians, the low rate of EMR usage may be taking the valuable time of health professionals away from patient care.
But there may be good reasons why physicians have not fully adopted digitization of patient records. One reason is that different EMR systems cannot communicate with one another.
As a result, with patchwork of different EMR systems used between hospitals, clinics and other allied health professionals, patient records are often still transmitted using fax machines.
Records are often then re-entered into different EMR systems.
“I fax everything,” said Kris Saunders, a family physician and President of the Medical Society of Prince Edward Island.
“I get 10 faxes a day of someone who ran out of a prescription. They call the pharmacy and say, 'could you fax it do my doctor and they'll fill that for me?'"
The lack of interoperability between EMR systems is a national concern. A recent editorial in the Canadian Medical Association Journal called for the adoption of a single EMR system for all primary care providers nationally.
On P.E.I., provincial hospitals have been using the CERNER system. An e-mail statement from Health P.E.I. said primary care providers use a number of systems, including OSCAR, Practimax, ISM and iCore.
Health P.E.I. began a pilot project in early 2018 for a streamlined EMR system for primary care providers. The pilot project, which has so far cost $200,000, involves a family physician’s office, a primary care network site, a home care office site and a provincial program site.
Health P.E.I. did not make available a representative to speak about the pilot project.
But Saunders believes physicians are keen to be more involved in the selection of an EMR system.
"We haven't really seen any findings at this point that make us feel confident that this is the best one moving forward," Saunders said.
Saunders said an inefficient or complicated system could be an even greater drag on the valuable time of doctors.
"It's not about getting an EMR, it's about getting the right EMR,” he said.
This is not the first time the province has attempted to establish one province-wide EMR system. In 2014, the province issued a request for proposals for a provincial EMR system. One system was put forward, with significant of support from physicians, Saunders said. But a statement from Health P.E.I. said the RFP was cancelled because the selected system “significantly exceeded anticipated costs.”
"There was one final vendor that was chosen. But after that, it seemed that there was an election time and that sort of desire went away," Saunders said.
Despite this, both Grimes and Saunders said P.E.I.’s small size has allowed its healthcare system a golden opportunity do away with filing cabinets and fax machines.
"Even though we've been slow to adopt these, we could leapfrog the rest of the country and be a leader in technology. It doesn't take much; we're so small and nimble,” Saunders said.
EMR use amongst primary care physicians (2017)
N.B. 62 per cent
N.S. 85 per cent
P.E.I. N/A*
N.L. 55 per cent
*Sample size too small
Source: CMA Workforce Study
