Technology in Practice: Electronic Medical Record System Adoption
March 7, 2018
Leanne Loranger, PT, Manager Policy and Practice
Electronic medical record systems (EMRs) are no longer a rarity in physiotherapy practice. Once the domain of the early adopter, these systems are increasingly common, and for good reason. The use of EMRs offers a wide range of benefits ranging from business efficiencies, to improved clinical care, and health system benefits.1
Most integrated EMRs include scheduling, billing, and charting functions, helping to streamline business processes and reduce the administrative burdens of physiotherapy businesses.1 EMRs also come with decreased record storage costs compared to paper records and provide easy access to patient records on request (no more digging through a dusty storage room searching for misplaced files). They tend to be easier to read (no more indecipherable notes), include reminders and triggers to help clinicians remember to complete their charting, and offer the ability to pull forward information so important patient details (allergies or other alerts) are always kept top of mind.
Some systems also include patient portals or integration with other systems, offering a way for physiotherapists to securely share education materials, exercise instructions, or messages with patients.1,2,3 As interest in sharing video clips of patient education or exercises has grown, some EMR systems have responded by increasing their ability to record, store, and share these types of files in addition to traditional documentation.
Time for a change?
When these benefits are considered together, it’s easy to understand why many physiotherapy businesses have made the move to an EMR. If you haven’t already made the switch, it’s probably time to start planning for it.
Both Alberta Health and Alberta Health Services (AHS) have current initiatives related to EMRs and EHRs (electronic health records) that are likely to impact Alberta physiotherapists. Alberta Health Services’ “Connect Care” project is currently working to harmonize and integrate all of the systems currently in use at AHS sites with the aim of achieving the goal of “one patient, one record” regardless of where the person receives services within AHS.4 Alberta Health has made it clear that their goal is even broader: to make the patient record a comprehensive one, inclusive of records of services delivered outside of AHS, including records from community-based, privately funded health-care providers.5
Both are working to provide patients with access to the information contained in their health records.4,5 To be clear, it’s not just Alberta Health and AHS, patients are asking for change – changes in the ability to access health information and changes to what the health record encompasses. The promise of improved communication, quality care and efficiency of services are key drivers of these initiatives.
This particular meeting of interest and investment may well represent a critical moment for health care in Alberta. While that fully interoperable (able to communicate and exchange data) record may still be years away, it’s time to plan for it.
How will this all work, anyways?
Although the terms electronic health record and electronic medical record are often used interchangeably, they are two distinct products. Electronic medical records are used to record clinical encounters in detail. They are the electronic equivalent of a traditional paper record.
In contrast, EHRs (such as AHS’ Netcare) retain summary data about patients and their episodes of care, without the day-to-day treatment details. An EHR would typically contain discharge summaries from different episodes of care, surgical reports, and results such as laboratory and diagnostic imaging reports that summarize the major events in the patient’s health history.1 EHRs “pull” data from EMRs to create these summaries.
When the desired future state of a fully interoperable EMR/EHR system becomes reality, specific details and data points contained in the EMR will be “pulled forwards” into the EHR, contributing to the overall record, history, and clinical picture of the patient in question. The key point being that the EMR and EHR must be able to “speak” to each other.
What’s required to achieve the future state?
Given the time and monetary investment that EMR adoption requires, it’s reasonable to ask “what’s in it for me?” After all, as desirable as it is for physiotherapists to contribute and have access to the comprehensive patient information contained in Netcare, physiotherapists have waited for years to have access to that system, and access is not anticipated in the near future. Why? What needs to happen to bring this desired future state to reality?
Legislative and policy change
Without a doubt, one of the biggest required changes is one that physiotherapists have little control over. The pace of legislative change is grindingly slow, yet to have a truly interoperable EMR/EHR system, one where physiotherapists have access to the EHR and contribute to it, changes to the Health Information Act are required. Specifically, physiotherapists will need to become eligible to be custodians under the HIA before gaining access to Netcare. Physiotherapy Alberta has advocated for this change for several years and will continue to do so.
Similarly, significant changes in attitudes, policies and processes will be required to make the goal of patient accessible records a reality. Are you prepared for the day when your patient can read your charting and their test results, perhaps even before you have the chance to? How will this impact the therapeutic relationship?
Interoperable EMR/EHR systems
Clearly the EMR and EHR will need to be designed to communicate and share information for data to flow from the EMR and contribute meaningfully to the EHR. Physiotherapists will need to help to identify the data elements that should be incorporated in the EHR.5 This isn’t just about providing summary data, but also about making sure that data provides information about quality practice and patient outcomes, enabling analysis and quality improvement efforts to further enhance the value of physiotherapy services.
Physiotherapists will also need to provide input to ensure that interoperability with commonly used EMRs is achieved.
Widespread EMR adoption
The element most in the control of physiotherapists is the choice to adopt EMRs in their clinical settings and to embrace and fully leverage the opportunities that these systems provide. While it’s interesting to think about what the future may hold when EMR/EHR interoperability is realized, the reality is that with adoption of these systems, clinicians and business owners will have increased access to their own data and the ability to monitor patient outcomes and adherence with clinical best practices, furthering their internal quality improvement efforts. At present, this is the best reason for physiotherapists to adopt EMRs.
Privacy Impact Assessments
As much as patients want to have access to their own data, and for clinicians to have the ability to access and share information to optimize their care, they also want to know that their information is secure and that no one has access that they should not have. One mechanism to help ensure private information is protected is to complete a privacy impact assessment (PIA). A PIA is an evaluation to help people who store private information to consider what information they store and the measures they have in place to protect that information. Working through the process of completing a PIA can help to systematically review the private information collected, how it is used, and the measures in place to protect that information. The process can then help to identify any additional measures to adopt to better protect private information.6,7
While PIAs are not currently required for physiotherapists, they are strongly recommended. They are also a requirement for all health information custodians who wish to have access to Netcare. Physiotherapy Alberta is also aware of several situations that physiotherapists have encountered which could have been avoided if a PIA had been completed before adopting a particular system or technology.
The transition to widespread EMR use and EHR integration will not be fast, and it is far from simple, but this is the clear direction we are heading.
Clinicians who have not yet adopted an EMR are strongly encouraged to consider doing so. Not only is this the direction of the future, it offers benefits to the patient, the practice, and (in the future) the health system as a whole.
The completion of a PIA is a worthwhile activity regardless of physiotherapists’ access to Netcare, and will help to identify the measures in place to protect private information, and those to adopt to best protect the patient private information physiotherapists are entrusted with.
Canadian Physiotherapy Association, Physiotherapy Association of British Columbia. PABC EMR Toolkit: Implementing electronic medical records in private practice physiotherapy settings. ND.
Practice Perfect. Practice Perfect Features. Available at http://practiceperfectemr.com/features/. Accessed February 27, 2018.
Jane Software Inc. Jane Features. Available at https://janeapp.com/features. Accessed February 27, 2018.
AHS. Connect Care. Available at https://www.albertahealthservices.ca/info/cis.aspx. Accessed February 27, 2018.
Rabi D. & Chemali B. Health Information Exchange: Engaging Providers in Health Care Innovation. Discussion paper – Commissioned by the Health Information Executive Committee (HIEC). Available at https://obrieniph.ucalgary.ca/files/iph/white-paper-health-information-exchange-engaging-providers-in-health-care-innovation-01.03.2017.pdf. Access February 27, 2018.
Office of the Information and Privacy Commissioner of Alberta. Privacy Impact Assessments. Available at https://www.oipc.ab.ca/action-items/privacy-impact-assessments.aspx. Accessed February 27, 2018.
Office of the Information and Privacy Commissioner of Alberta. Privacy Impact Assessment Requirements. Available at https://www.oipc.ab.ca/media/117453/guide_pia_requirements_2010.pdf. Accessed February 27, 2018.