There are many aspects of IT in health care that are exciting, innovative, and essential to our ability to cope with demographic trends over the next few decades. However, most commentators on IT in health care don't discuss any of that. Instead, the entire IT in health care dialogue is dominated by the issue of electronic medical records (EMRs). During a recent speech on the topic, I put up two lists that I hoped would help clarify the obstacle that prevents the grand plans around EMRs from driving widespread adoption.

The first list read like this:

Funders and policy professionals

Researchers

Specialists

Patients

Family physicians

The other list included:

Family physicians

I think the two lists illustrate an important point. The first could be called "EMR beneficiaries;" it captures, in roughly declining order, the groups that will benefit from implementation of EMRs. Funders and policy professionals -- the people who most often are advocates for grand EMR mandates -- will benefit immensely from having consistent information on patient requirements, treatments and outcomes as the basis for budget and policy assumptions. Researchers will also benefit hugely from this information, using it to investigate correlations that can not currently be traced with any real accuracy. Specialists benefit, because they have access to longitudinal records on patients that they may see only once, or in a limited context. And patients may benefit from improved health care delivery resulting from better overall coordination across the system, though this benefit will only accrue through effective use of this data, not merely from its existence.

The family physician? He or she gets some benefit from a more complete record. But -- currently, the family physician has the most complete record on a patient. Gains at this level are pretty incremental, and may not have a huge influence on real-world treatment.

Let's look at the other list, which could be titled, "People who have the responsibility for making EMRs a reality." Here, the family physician really stands alone. An EMR is most useful if it considers history as well as recent treatment -- and that history is most often contained in a manila folder in a doctor's office.

To create EMRs for patients old enough to have medical records, data regarding the details of their office visits, ailments and treatment history need to be extracted from pages covered with handscribbled script.

So - not only does the family physician benefit least from EMRs, but he/she has the data that they require stored in filing drawers, in a digitally unfriendly format.

Who resides in this doctor's office? Typically, one or more very busy physicians: I have heard that in Ontario, a primary care physician sees a new patient, on average, every seven minutes. The doctor is generally assisted by a nurse; a receptionist may serve one or several doctors, dealing with appointment requests, welcoming patients, and ensuring that the associated paperwork is kept straight. None of these people has a great deal of spare time that could be dedicated to translating paper records into EMRs. What's more, "the boss" -- the doctor -- did go through nearly a decade's worth of post-graduate courses and late-night intern shifts in order to manage data. They entered medicine to treat patients.

A plan that requires physicians to change behaviour to make EMRs a priority will fail, for the simple reason that they will not make EMRs a priority -- they will make patients a priority, and the funders, researchers, specialists and even patients will need to accept that this compulsion will not be changed by a policy mandate, and that there is not enough free investment capital in the system to create a parallel data management bureaucracy that operates at the level of the individual physician.

Does this mean that family physicians will eternally block the implementation of EMRs? Of course not. There is a generational issue in play, as younger physicians are more comfortable maintaining electronic records than paper ones. And there is the reality that as other care sources -- institutions, pharmacies, specialists, etc. -- are linked electronically, the family physician's record is no longer the sole important source of patient information. However, in the "near term" -- and in health care, that may be immediate, but it's not a transitory state -- EMRs will advance incrementally, rather than at the behest of a sweeping mandate.

Initially posted by Michael O'Neil on IT in Canada. Reposted via agreement with IT in Canada.