EHR? ASAP!

Canada Health Infoway promoted electronic health records (EHR) in the Globe and Mail this weekend (online here). CEO Richard Alvarez says Canadians should "demand" EHRs. If the public only knew how ridiculously wasteful the current system is, "demand" would be putting it lightly.

I've explored the concept of muda in my Advanced Access blog, but here's some examples of wasted time, energy and money from one day in my practice.

7 a.m. hospital rounds: 4 patients to discharge after prostate surgery. Same instructions written out manually on 4 charts. An electronic system would allow routine orders to be bundled together and added to a patient's digital chart with a single mouse click. (Please let me log into this system with a fingerprint or retinal scan. Don't make me go through password purgatory!)

A man with blood in his urine needs a kidney ultrasound. I fill out the requisition and indicate the clinical problem. Hope the radiologist can read my handwriting. Once again, common tasks should be automated.

8 a.m. Seeing a man with a kidney stone. He had an X-ray done yesterday in his home town, 1.5 hours away. I have a verbal report, but his doctor didn't send the films so I can't review the study myself. Our new PACS (on-line X-ray storage system) went live last week, so I can access any films done in Saskatoon, but it doesn't give province-wide access yet. I have to repeat the X-ray in order to make a diagnosis and recommend treatment. Muda tally: Waste of his time, my time, X-ray technologist's time, extra dose of X-rays and cost to the taxpayer.

10 a.m. Elderly man referred to see me because he's having difficulty passing his urine. Family doctor's letter is, shall we say, brief. No indication of other medical history, medications, allergies or results of previous tests. I ask about his medications. He's on a blue pill and a little white one. No idea what the names are. Helpfully, he says that his doctor should have a record of all his pills. No doubt his doctor does. A universal EHR would mean I could access all his history, medications and test results instantly, saving time and reducing chance for mistakes or faulty memory.

11 a.m Review lab results received today. We use an electronic medical record program in our office. (It's basic, but is a huge improvement over hunting through paper charts.) Our health region's lab has its results in electronic form. Sounds like a match made in heaven, huh? Hey, Lab, why don't you just electronic those results right over to us?

Well, they can't. Actually, they can, because they do it for other doctors' offices in our region, but they can't do it for us. I've asked several times and the reason seems to be that they don't have the proper (insert random, unconvincing technobabble here) for our program and we'll just have to wait our turn to get connected. It's been about 2 years now.

In the meantime, they fax us the results and we scan them into our system. It's a crazy Rube Goldberg machine. Not only does this waste my staff's time, there's a huge opportunity cost. Because the lab results only exist in our system as scanned pictures, the system doesn't really "know" what the results are. We can't follow results (such as PSA levels) over time without having to manually enter every single result. We can't search for abnormal results. We could be doing so much more with this information.

These examples are just about shuffling data around. That's peanuts! An EHR could harness computer-assisted decision-making, show current evidence-based best practice, alert me to medication interactions, help patients be more informed and involved in their care, the list goes on...

I want my EHR!