Doctors push back on fast Epic rollout in NL

ST. JOHN’S, NL – Doctors in Newfoundland and Labrador say rapid implementation of a province-wide electronic health information system threatens to harm patients and push some physicians to retire or leave the province. The province’s health authority says its electronic health information system, CorCare, based on the Epic software platform used in many parts of Canada and the U.S., is set to launch on April 25.

N.L. Health Services says CorCare promises to modernize healthcare by providing a single, integrated digital record to improve patient care, efficiency and data sharing across the province.

However, physicians in the province have concerns about how it’s being launched. More than 250 of them have signed a petition calling on the province’s health authority to stagger the rollout of the CorCare system so it’s put in place gradually, in phases.

Dr. Bolu Ogunyemi, a dermatologist in St. John’s, expects a province-wide electronic medical system will ultimately improve healthcare in Newfoundland and Labrador but he signed the petition and a letter to the province’s health authority because he believes the way CorCare is being implemented is flawed.

“When you have too much going on at once in multiple settings, that introduces potential risk to patients,” he told CBC News.

“Even if one blood test gets missed, or another test or investigation or imaging, that can have real results for patients, whether it gets missed or whether it gets delayed – that’s unacceptable.”

Community physicians, those who operate their own businesses and bill the province on a fee-for-service basis, have concerns about the 35-page agreement they are required to sign to access the new system for their patients.

They want CorCare Link, the part of the system that gives physicians in the community access to CorCare, to be delayed and some of them don’t believe it should be mandatory.

“Being mandatory is just… it really doesn’t sell Newfoundland and Labrador as a province where physicians would want to stay and work. Nobody wants to work with a bully, saying you have to sign this in order to do this [have access to CorCare]. I mean, that’s not a partnership, that’s a dictatorship,” Dr. Sarah Tulk (pictured), a family physician in St. John’s, told CBC News.

“It doesn’t make someone want to come here and work here, especially when we already do have quite a bit against us in terms of our medical system.”

Both Ogunyemi and Tulk said they have spoken with physicians who’ve said they’ll retire early rather than accept the CorCare implementation as it stands.

Both said it could seriously hinder the province’s efforts to recruit and retain doctors at a time when the province already has a physician shortage. Access to a family doctor in N.L. already lags behind the national average, Ogunyemi said.

A report from the Canadian Medical Association found an estimated 29.1 percent in the province don’t have one, compared with about 17 percent nationally.

“We’re really just kind of keeping above water here,” he said.

One part of the agreement physicians must sign to have access to CorCare is particularly troubling to some. They say the agreement would give them liability, making them financially responsible for breaches of the health information system. They fear they could be on the hook for the cost of dramatic cyberattacks like the one in October 2021.

“If they’re not flexible and aren’t able to make changes, then I think that there will be practice closures….there will have to be because as it stands, I can’t sign that contract,” said Tulk.

“I don’t know that I’d have to close my practice if I couldn’t. I might be able to try to find some creative workarounds for some of my patients. Like, I’ll certainly try my best for them.”

Tulk says it could be a real problem for physicians who still use paper medical records and it could have repercussions for their patients.

“There are some family doctors who still run on paper-based practices who are providing excellent care to massive patient rosters, who have said that they simply can’t do this. So if NLHS really, really wants to reinforce that this is going to be mandatory, they’re essentially forcing those physicians … out of practice and that is a patient load that the system is not going to be able to absorb,” she said.

A letter, signed by Dr. Ogunyemi and six other community-based physicians, was sent to the provincial government and the health authority. It was titled “Urgent: A call for safe and fair implementation of CorCare and CorCare Link.”

“NLHS has acknowledged that the launch of CorCare will result in reduced patient access during the transition period,” the letter states. “Proceeding with a concurrent rollout of CorCare Link risks compounding these disruptions across both NLHS-based and community-based care at the same time. This creates a real and immediate risk of decreased access to care for patients across the province.”