Jeremy Smith
Today in British Columbia around 60% of physicians in private practice offices are using an electronic medical record (EMR), and that number is moving steadily upward every year. This upward trend of EMR adoption offers a new opportunity to address the growing challenge of providing quality health care to an aging population.
According to a recent survey by the business firm Deloitte, the number of those surveyed who have one or more chronic diseases has risen from 47% in 2009 to 52% in 2011.
Fortunately, the baby boomer generation, now turning 60, is a cohort of people who are used to being proactive about politics, about the environment, and now, increasingly, about co-managing their own health.
In this article we profile two patients and their physicians who are taking advantage of the EMR’s capacity to present data that help track and manage chronic diseases and support active collaboration between patient and physician.
The view from the patient’s chair
Ms Lesley DiZazzo is a 55-year-old Powell River woman with numerous chronic health issues. She has been a patient of Dr Bruce Hobson since 2008, and she herself had previously kept records such as kidney function, blood pressure, and blood glucose levels. As she says, “One doctor told me that I had to be careful not to fall through the cracks [of the health care system] due to the number and complexity of my chronic diseases.”
When Ms DiZazzo first visited Dr Hobson she soon realized that he had already entered all of her information into his EMR. She was happily surprised when she was sent reminders that it was time for a blood test (to monitor kidney function), blood glucose levels, or to do a serial blood pressure reading.
She adds, “He would follow up on topics from a previous appointment to monitor how I was doing with each condition, including severe chronic pain and an intense sleep deprivation/sleep disorder. Dr Hobson frequently has very current study results that pertain to my medical issues at hand or actually on his computer screen ready for us to discuss. Seeing a graph of my GFR is a powerful visual aid—much more meaningful than a number. As a former teacher, I appreciate the educational opportunities that exist in the doctor-patient relationship when the EMR system is used for visual display.”
Ms DiZazzo also appreciates that Dr Hobson can easily track her list of 19 current medications, their interactions, and refill schedules for each. Because she also sees a number of specialists, those reports are added to her EMR, creating a timely, complete, and easily accessible record for both patient and physician to see and use.
Overall, she says, “I continue to be very involved in my health care and Dr Hobson and I make a great team. With his very thorough use of EMR, I do not need to remind him of reassessments. My time with him is spent very efficiently and we are able to cover so much more. I am always confident he will be able to share any new developments that could pertain to my health care and that any questions I have will be answered with the help of the computer or he will make a note on the computer to find the information.”
When asked about the impact of EMRs on patient care, Ms DiZazzo concludes, “As patients become aware of the EMR system and become educated about its benefits to their medical care, they will be looking for doctors who incorporate this technology into their practice.”
Ms Esther Brown, from the town of Oliver in the south Okanagan, provides another positive perspective on how her physicians’ EMRs have helped her to cope with rheumatoid arthritis and other chronic illnesses, such as elevated blood pressure and kidney disease.
Currently, Ms Brown is under the care of family practitioner Dr Robert Calder in Osoyoos and Dr Jacqueline Stewart, a rheumatologist in Penticton, and is about to be seen by other specialists who use the e-referral network that allows physicians to electronically exchange patient chart data in order to provide more coordinated shared care.
In her words, “The physicians easily and quickly share each other’s assessments, lab tests, and other procedures. With the EMR I can easily see how the care team (including myself) is involved in the management of my health issues. By seeing all of the test results and medications on the screen and getting print copies if I request them, I have a much greater sense of involvement in and accountability for my own well-being.
“Being a patient working with physicians who are easily networked and proactive I don’t have any anxieties about procedures or recalls being missed, and this gives me a great sense of security, which also contributes to my overall health,” she adds.
A physician’s experience
Dr Calder is a member of a group practice at Osoyoos Medical Centre in a town that contains a large proportion of people over 65. Over the 2 years since implementation he has become an enthusiastic user of the clinic’s EMR to proactively manage the care of approximately 1300 complex patients.
One example is his use of a report showing patient age and gender to identify and contact women between the ages of 50 and 80 with a reminder to have a mammogram. In addition, he writes a personal letter to those who have not been tested and describes the test and its benefits.
As he says, “I have found that by using the EMR data to identify the group at risk, then using pop-up messages during the patient visit as reminders to ask the question, combined with the proactive letter and better visual aids that demonstrate the size of a breast tumor detected by a mammogram, I have increased the testing rate of patients from 60% to 70%.”
When it comes to prostate cancer detection Dr Calder also takes a proactive approach. So far his data show that 70% of the males in his practice aged 50 to 70 have had a PSA. For the remaining 30%, he writes letters with a lab requisition included. The proactive approach based on data has had a positive impact: “By these methods I have found three prostate cancers that we may have otherwise missed.” He also uses this approach to encourage patients to participate in screening for colon cancer.
Dr Calder also uses patient data to ensure that he is proactively working with people with diabetes, hypertension, renal failure, and other chronic conditions.
When asked if being on an EMR saves him time, Dr Calder responded, “No, not at all, because the time I save by not flipping through endless paper charts now goes to spending more quality time with my patients, and therefore I feel like I am doing a better job of patient care.”
—Jeremy Smith
PITO Program Director
