U.S. physicians looking for more evidence of the value of electronic medical records (EMRs) may want to consider the experience of their colleagues to the north. A newly released study commissioned by Canada Health Infoway found that primary care practices with EMRs identified patients who need preventative or follow-up care approximately 30 times more quickly than paper-based clinics.
Eleven community-based primary care clinics, including 21 individual physician practices, took part in a one-day Practice Challenge. Seventeen practices used EMRs while four practices used paper-based records. The clinics are located in British Columbia, Ontario, Quebec, Nova Scotia and Newfoundland.
An expert panel of family physicians identified six evidence-based interventions from which specific types of patients could benefit: immunization, follow-up care after a heart attack, cancer screening, diabetes management and two medication recalls. For each, practices were asked to identify patients in their practice who qualified for that intervention. Those practices that did not complete the chart review by a set cut-off time recorded the percentage of charts that they had reviewed.
Researchers from St. Mary's Research Centre, MedbASE Research and McGill University compiled the results.
Practices using EMRs reviewed the records of all their active patients in an average of 1.4 hours. Paper-based practices of approximately the same size reviewed 10 percent of all active charts in 3.9 hours, which means that they would have needed an estimated 40 hours to conduct a full practice review.
Practices with EMRs were also more confident in their ability to contact all the right patients to receive the appropriate treatment or intervention in a timely manner. On a scale of one to five, where 5 is very confident and 1 is not confident, EMR-based practices were more confident in their reviews than paper-based practices (average score of 3.8 vs. 1.9).
"These results demonstrate the value of EMRs in enabling clinicians to deliver high-quality patient care in a timely fashion," said Richard Alvarez, president and CEO of Canada Health Infoway. "The good news is that the number of family physicians using EMRs has grown significantly in recent years, improving quality of care and supporting more efficient care delivery in practices across Canada."
The basis for the Practice Challenge is an approach to primary care called practice-based population health management. It uses information to help improve care and clinical outcomes across the patients in a given practice. This can include common tasks, such as helping patients with hypertension to manage their condition, or less-frequent yet critical tasks, such as a medication recall where timeliness is essential. This approach to care has been cited by the College of Family Physicians of Canada as a key element in the transformation of primary care.
In a 2012 Harris Decima survey, 73 percent of Canadian respondents agreed that they should receive reminders if preventive or follow-up care is recommended because of their age or health problems. Most of these individuals (85 per cent) felt that reminders should come from their family doctor or regular place of care.