Friday, October 26, 2007

Reporting my data

OntarioMD has now announced that two new companies have been approved for ASP funding. My EMR software is one of them. This is good news for my group; our contract finishes in a year and a half, and we will be looking at whether we should then transfer to the ASP product. Doing this will mean that our software will be hosted in the SSHA Data warehouse. Other services, such as home care and some public health data, will be hosted there as well. I am sure there will be lots of bugs and difficulties, but this represents the future of health care in this province; it represents the best chance of integrating health care.

I went to the North American Primary Care Research conference last weekend. There was palpable excitement about what is happening with computerization in primary care. There were many presentations dealing with this subject.

As I look at my data over the past year and a half, I can see how valuable it is. Everything possible is going into the EMR now. It bothers me that Diagnostic Imaging reports continue to be reported on paper (despite the fact that DI is highly computerized), and that hospitals are still not connecting. That is unsafe and bad for patient care.

We also continue to receive stacks of paper from the Ministry of Health for our roster lists (list of all patients signed up with a family physician), every three month. These are generated by a computer, is there no way to receive them electronically, and match them with the EMR roster list?

It is now time for us to think about how to give our data back safely, and with full privacy protection. This data can and should be used to improve our health care system. For example, there is much talk about Wait times, and a lot of money is being poured to improve this. I don't really know how good the data is. In my EMR, we routinely collect wait time data as part of everyday care. When I send a patient for Diagnostic Imaging, the requisition is generated in the EMR (with a time stamp). This is the same for a specialist referral. When the specialist's office notifies us of the date, my secretary calls the patient and enters the date into the EMR. When the letter or DI report comes back, it is matched with the req (so we know it has been received), and that date is stamped in as well. I think it is now possible to start reporting on wait times from primary care, which is what is most relevant to patients. I think the public has a right to know, physicians and other health care providers should know, and our government (which funds health care) would want to know. If you don't know there is a problem, it is very difficult to fix it.

I do not think most of my colleagues would have much of a problem with this, provided privacy is strictly safeguarded. I think there is large value for patients as well, with the same caveat. I know I have several colleagues who are thinking the same thing. It is time to get going on this.

One of my colleagues was mentioning the fact that proprietary requisitions seem to be proliferating. Every specialist and hospital program wants their own, usually based on a paper form. This is not the way to go. I generate generic requisitions for DI, and have started generating EMR based reqs for Diabetes education. I simply append their form on the top, with "see attached". That seems to work. Dr Brookstone in BC has managed to get programs in his area to post their reqs on a secure website, but it takes work to make sure this is regularly updated. It is better than what we have here, which is nothing. I think it should be the responsibility of programs to make sure they are accessible when needed. Give up on proprietary forms (health is not proprietary), and make all programs accessible from a common area. Toronto211 is a good example for community and social services, we need something like that for medical programs.

It is time to ensure that the necessary data is there, both for our patients and for our health care system. I can see this is starting to happen now.


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