Physician IT

CMA says bigger investment needed in doctors’ IT

OTTAWA – The Canadian Medical Association (CMA) has released a new health information technology (HIT) investment strategy that aims to reboot Canada’s HIT agenda to better focus on supporting front-line patient care.

Called “Toward Patient-Centred Care: Digitizing Health Care Delivery,” the document is available at: www.cma.ca/media. The strategy says that $410 million for physician EMRs and $310 million for transition support are needed over the next five years. (The CMA applauded Canada Health Infoway, which announced it would invest $380 million in physician IT; to complete the work, however, more funding will be needed, according to the CMA analysis.)

“There is no question that we need to accelerate health information technology adoption in Canada,” said Dr. Jeff Turnbull (pictured), President of the CMA. “As we strive to accomplish that though, we must target our investment toward direct patient care, where it will help the most.”

Canada continues to lag internationally in terms of the use of electronic medical records (EMR) in primary care practice. The most recent Commonwealth Fund study conducted in 2009 indicates that only 37% of Canadian primary care physicians use some form of EMR. That compares to 99% in the Netherlands, 97% in New Zealand, 96% in the UK and 95% in Australia.

Given the uneven success in HIT implementation across Canada - specifically in terms of front-line patient care – the CMA considers the new 5-year investment strategy to be an integral component of the CMA’s “Health Care Transformation in Canada: Change That Works. Care That Lasts,” a document released in August.

“Most patient care in Canada occurs in primary care settings, yet most health IT investments made to date have centred on large-scale systems,” said Dr. Turnbull. “We want investments that translate into tangible benefits, namely improved patient care and better outcomes.”

Transforming the health care system hinges on building better tools and supports to help health care professionals interact and provide care for patients. To that end, the HIT strategy prioritizes the key clinical and system priorities for investment over the next 3-5 years as follows:

• chronic disease management;

• prevention and health promotion;

• medication management;

• continuity of care (information flow, access and wait times);

• patient involvement; and

• public health reporting.

To help guide this agenda, the CMA strategy lays out a clear plan of investment activity and sets three interim goals: significant adoption of EMRs in ambulatory settings; accelerating the exchange of health information; and more effective use of EMRs and related solutions.

According to the CMA document, investments in the following major building blocks of the EMR strategy will be needed over the next five years:

• $410 million for EMRs. Approximately 49,200 physicians (GPs and specialists) in Canada have a clinic outside of an acute care setting. Of those, an estimated 18,200 already have an EMR. A further 10,500 will be covered by the current programs in five provinces that fund physicians to acquire an EMR (program estimates up to 2014.) This leaves an unmet need of approximately 20,500 physicians who will need funding to acquire an EMR. Helping these physicians adopt EMRs would require an investment of approximately $20,000 per physician.

• $310 million for transition support and change management. Experience has shown that a strong transition support and change management program is required to ensure the effective use of EMRs in clinical settings and address transition problems. The estimated cost per physician for a well-developed change management program is equal to the hardware and software purchase cost of $15,000 per physician. To support the 20,500 physicians who still need an EMR requires an estimated investment of $310 million.

• $10 million for functional requirements for specialists. Community-based specialists and surgeons have unique workflow and technology requirements that need to be addressed to increase EMR adoption. Building on work already done by the Physician Information Technology Office (PITO) program in B.C., this investment would be used to identify functional requirements for specialists that should be included in EMR product design, the e-referral process, hospital interfaces, unique device integration and documentation requirements.

• $5 million for data migration. The EMR marketplace in Canada is still immature and within five years only four or five vendors are expected to dominate. This means that over the next five years many physicians will need to migrate to different EMR products as vendors go out of business, consolidate, are excluded from government funding, etc. Investment is required to finalize a data migration standard that should be built into all future specifications for any EMR in Canada to ease the data migration process.

The analysis leading to the cost estimates in the CMA strategy takes into account the forecasted adoption levels for the five provincial programs that fund EMR adoption - BC, Alberta, Saskatchewan, Ontario and Nova Scotia. The CMA estimate of $410 million for physician EMRs and $310 million for transition support is over and above the current provincial funding programs.

The CMA is encouraged by the recent announcement of Canada Health Infoway to allocate $380 million toward EMR adoption and integration of points of care, two of the main goals in the strategy.

Posted October 7, 2010