Physician IT

Strengths, weaknesses in physician use of IT

OTTAWA – Seventy (70%) of Canada’s physicians have high-speed Internet connections in their office, and 68% of the doctors say they’ve got intermediate or advanced skills with computers, according to the National Physician Survey, which just released the results of its 2007 polling.

That’s a surprisingly high level of skill and readiness – and it’s at odds with traditional views of Canada’s physicians. In the past, doctors have often been perceived as Luddites who turned up their noses at computers.

The National Physician Survey is a joint project of the College of Family Physicians of Canada, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada. The partners are surveying GPs, family docs, specialists, medical students and residents across Canada every three years to examine what they’re doing – or planning to do – in their practices.

The 2007 National Physician Survey contacted 60,811 Physicians. Of these, 19,239 replied to the survey, for an overall study response rate of 31.6%. Fifty-eight percent (58%) of eligible respondents were contacted initially by email, and the remaining 42% by regular mail.

Questions pertaining to the use of computers, electronic health records and other advanced solutions formed part of the survey.

Interestingly, 50% of the doctors say they use e-mail to communicate with colleagues for clinical purposes, and 13% are using e-mail to communicate with patients for clinical reasons. Only 10% of doctors say they don’t use e-mail.

It appears that physicians are now readily using e-mail as a technology that obtains answers to questions much more quickly than their traditional tools – telephone and fax.

No discussion was provided about whether physicians are using any forms of security or encryption when e-mailing clinical information or questions.

On the topic of patient records, most doctors are still using paper charts. According to the survey, 58% of physicians maintain paper records for their patients, while 26% have a combination of paper and electronic records. Only 9.8% use electronic medical records instead of paper.

Nicely, the survey makes a distinction between “having” an EMR and and actually “using” them.

In the case of EMRs, 25.7% of doctors say they are using electronic records to enter and retrieve clinical patient notes. (Specialists are more apt to use computerized solutions. While 23.6% of family docs/GPs said they use EMRs, 28% of specialists said they use them.)

Age also appears to be a factor in the use of EMRs – according to the survey, the older the doctor, the less likely is the usage of electronic records. For example, nearly 32% of physicians 35 or under use electronic records; 26% of doctors who are 45-54 make use of them; but only 18% of doctors 65 or older say they use EMRs.

While 30% of doctors use electronic connections to external labs and/or diagnostic imaging clinics, only 3.9% use a connection to an external pharmacy. Despite the potential benefits of e-prescribing for patient safety, this application is still in its infancy in Canada.

Another weak spot: while 19% of physician make use of electronic interfaces to other external systems for accessing or sharing patient information (such as hospital portals), a mere 2.3% have interfaces to chronic care registries.

Of this 2.3% who have them, 1.7% say they use them.

The low rate of connections to chronic care registries would certainly be worth further research and discussion.

Although patients with serious, chronic problems require close attention by caregivers, it is probably difficult to obtain fast, electronic access to their records.

Complicating matters is the fact that chronic-care patients are likely to have records in a variety of locations – physician practices, hospitals, long-term care centres, and specialist clinics. In some of these facilities, the records may not yet be computerized!

Nevertheless, some progress is being made. As a better way of caring for patients with chronic diseases, some jurisdictions are now building targeted ‘patient population’ registries. For example, the Kitchener-Waterloo area of Ontario has developed a cardiac care database for the region’s heart patients. (See Canadian Healthcare Technology’s April 2008 issue for a profile of this innovative, cardiac-care registery.)

On another front, use of wireless technologies by doctors is surprisingly low, according to the report. For example, only 2.5% of physicians use wireless systems to enter and retrieve clinical patient notes.

Only 4.6% of physicians use wireless warning systems for adverse prescribing and/or drug interactions; 4.5% use wireless applications for decision support.

No reasons are given for the results; perhaps doctors are concerned about the security aspects of wireless systems.

IT-related issues constitute only one part of the extensive NPS survey. Other principal findings of the report included the following:

Patient access to specialists
• 71% of family physicians ranked access to psychiatrists in Ontario as fair to poor, compared with 45% of family physicians in Saskatchewan.
• 61% of family physicians in Quebec ranked access to orthopedic surgeons as fair to poor, compared with 26% in Prince Edward Island.
• 72% of family physicians in Prince Edward Island ranked access to ophthalmologists as fair to poor, compared with 25% in Saskatchewan.
• 57% of physicians in British Columbia and Saskatchewan ranked access to diagnostic services (e.g. CTs and MRIs) as fair to poor, compared with 34% in New Brunswick.

Several significant trends in physician practice patterns are highlighted in the NPS results:
• Based on the 6% who plan to retire, we can expect upwards of 4,000 physicians leaving clinical practice over the next two years. Intentions to retire are consistent province to province.
• Gaps are being increasingly filled by a female physician cohort. Studies have shown this to have positive impacts on doctor-patient relationships, service organization, and access to services, while having significant implications for future resource planning. Currently, 33% of all family physicians under the age of 35 are women in Prince Edward Island, and this percentage rises to 72% in Quebec.
• In 2004, 26% of physicians planned to reduce their hours. The 2007 NPS confirmed that in fact 27% of physicians had reduced their hours over the last two years. Now, 35% of physicians plan to reduce their weekly work hours over the next two years – from 28% of family physicians in Manitoba to 37% of family physicians in Quebec and the Territories; and from 30% of other specialists in Prince Edward Island and Nova Scotia to 40% in Quebec.

“The NPS partner organizations challenge all levels of government and health authorities across the country to develop a pan-Canadian strategy that will effectively address the urgent issues identified in the NPS results that further threaten Canada’s health system,” said Dr. Ruth Wilson, President, The College of Family Physicians of Canada. “We need to work together to enhance the education, training, recruitment and retention of physicians to ensure a sustainable workforce that can meet the healthcare needs of Canadians in all provinces and territories.”

Complete survey data can be found at the National Physician Survey web site, located at: www.nationalphysiciansurvey.ca.