Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
The purpose of this document is to give you an introduction to medical information technology. Medical information technology comprises a wide array of tools used for information management. Some tools are being replaced with advances in electronic communication and recording and consequently, there is a spectrum of resources currently employed within family practice offices.
Information technology is used for:
- Scheduling patients
- Billing health systems, patients or third parties
- Recording and organizing patient information, e.g. electronic medical record
- Communicating by fax, telephone or email messages
- Office support tools such as word processing, spreadsheets, provider registries or personal schedulers
- Remote access to patient records from locations other then the physician's office
- Incorporating or linking to tools used for clinical decision support, chronic disease management and knowledge transfer
- Conducting practice research
Newer uses for information technology include:
- Rostering (enrolling) patients in primary care models
- Sharing patient information in expanded shared care primary care models
- Managing patients during a pandemic
It is important to acknowledge that information technology itself is merely a tool that facilitates information management. The management of patient information in family practice is not new. As the custodian of each patient's recorded medical information, family physicians are in a unique position to adopt newer electronic means of obtaining and sharing this information. In turn, health authorities have an increasing interest in accessing electronic patient information for population health needs planning. With privacy and confidentiality legislation related to patient information assuming increasing prominence, the family physician as the main custodian of the patient's medical information, plays a pivotal role in the creation of the electronic health record.
Most family physicians use information technology in practice for billing purposes and word processing. Some also use it for connecting with external laboratory or information systems. More recently, some family physicians have taken an increasing interest in the use of technology in the development of electronic medical records. But this has been slow in adaptation as well as adoption. According to the National Physician Survey 2004, only 14% of family physicians use electronic medical records. Nevertheless, Canada Health Infoway has a goal to ensure 50% of the population has an electronic health record (EHR) by 2010. More recently (January 2006), the Health Council of Canada stated this goal should be changed to 100% of Canadians by 2010.
There are many reasons for the lack of more rapid progress and these will be identified in the contents of this document. Nevertheless, the electronic medical record as a repository for patient information is gaining increasing approval from those practitioners who use it, often with resources that promote better access to and management of this information. And as family physicians seek better and more efficient or effective ways of improving patient care and communicating with one another, the health system and their patients, they become more open and receptive to the use of information technology.
There is a growing body of knowledge pertaining to the advantages afforded by information technology. For example, information technology has a role in:
- Supporting team-based care
- Reducing the potential to duplicate patient investigations
- Increasing the availability of institutional records
- Promoting better treatments including the more appropriate use of drugs
- Ensuring rapid access to clinical decision support tools, (e.g. electronic references, clinical practice guidelines)
Information technology has also been shown to improve office efficiency and staff utilization. (See Hunt et al and Mitchell et al under Other Resources below.)
One of the biggest barriers to the implementation of information technology has been the cost of transitioning a family practice or new models of primary care in that direction. Lack of progress in moving family physicians and other healthcare providers to more advanced electronic tools can be directly proportional to the amount of cost associated with implementation. In fact, many health jurisdictions struggle to reach agreement on how best to support family physicians in the implementation of newer technologies, whether electronic records or connectivity to laboratory and diagnostic imaging centres. An equally important and aligned aspect of cost is ensuring that physicians and their staff have appropriately compensated "protected time " for transition. It is significant that for the electronic health record, greater than 75% of the benefits may accrue to the health system, including governments, while less than 25% may accrue to the physician[**]. In short, cost will continue to be a significant deterrent to implementation unless governments and health authorities can improve the cost-benefit ratio for family physicians.
The other barrier that has been significant and deserves mention in this overview is the lack of agreement to standardization in the use of information technology within jurisdictions and across Canada. In turn, this has led to uncertainty that changes in technology will have longevity in practice, even if appropriate training is received or suitable financial assistance obtained. Jurisdictions that have addressed such barriers as costs and standards associated with the implementation of information technology appear to have been more successful in attracting family physicians who are willing to adopt newer systems.
(See Using IT to Make Primary Care Reform Work for You under Other Resources.)