IT provides hope for primary care

When I joined the BCMJ Editorial Board, I was introduced as someone who could bring added value to the Journal due to my interest and involvement in information technology (IT). Although I have been deeply involved in numerous projects over the past 10 years, it is only recently that technology has begun to significantly impact the way that I think and practise. The PDA is becoming the new stethoscope of the physician, the Internet is now an important information resource for physicians and patients, and finally there is growing momentum in the implementation of electronic medical record systems. Despite all this, we are still in the “baby steps” phase of the process.

My excitement with information technology is tempered by the state in which I find family practice. Family physicians are frustrated by the growing complexity of full-service care and the very real lack of value that is applied to their services as reflected in the growing disparity in fees between specialist and general practice. I recently attended the BC College of Family Physician’s annual conference and had an opportunity to listen to the executive director of the CFPC, Dr Cal Gutkin. In his opening address, Dr Gutkin stated that family practice was facing its greatest crisis in 50 years. Fewer physicians than ever were applying for family practice residencies and the valued full-service family practitioner could very well become extinct. A little later on the same day, a fellow attendee approached me to ask advice about her practice and how she could influence a reticent colleague to implement an electronic medical record (EMR) system. She could clearly see the potential advantages of an EMR in her practice and her enthusiasm was in direct contrast to the dismal picture that had been painted earlier in the day on the future of the profession.

Concurrently I am involved in an exciting process with Vancouver Coastal Health to develop a primary care information technology strategy for the health region. A number of my colleagues and I are intensely focused on developing a practical strategy that will allow physicians to move through the tumultuous transition to a more connected health care system. Although there are significant challenges, we have the benefit of being able to learn from other jurisdictions in Canada and other countries such as Denmark, New Zealand, and the UK. What has struck me from many of our meetings is the global role of the primary care physician in health care computing. Primary care physicians are the champions and leaders when it comes to information technology. This is true in every country that has a high uptake of computerization. The scope of family practice is significant because one has to interact with many parties in the course of the average day. Each interaction is essentially an interface that has to be duplicated in the electronic world. The scope of these interactions is what makes primary care challenging and it is this challenge that has driven a generation of primary care physicians to become leaders in the world of information technology.

The take-home message is this. The enthusiastic colleague that I met at the BCCFP meeting is the champion of tomorrow. Crisis creates a need for dramatic solutions and it is simplistic to believe that any one factor will rescue family practice; however I believe that family physicians will lead this next wave of change as they have done across the world. The IT-enabled primary care physician of the future will be a highly adept specialist. Let’s hope that the system recognizes and rewards these champions appropriately.

—AJB