*Francisco Jose Grajales III; Samuel Sheps, MD
University of British Columbia
Oral Presentation – Research Track
Saturday, Sept 29, 2012: 12:58 PM – 1:18 PM – LK130

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*Presenting Speaker

Objectives
Despite minimal independent research, over the last five years electronic medical records (EMR) in Canada and, more specifically, British Columbia, have been the subject of arduous debate. This presentation reviews the existing literature, the recent BC experience with EMRs and makes several recommendations for improved implementation.

Approach
While the peer-review literature provides mixed evidence that EMR may improve the quality of primary care and improve significant health system costs; the practical approach and physician implementation of these specialized information systems remains a complex, unresolved, and under-researched problem for all actors – policymakers, physicians, vendors, and patients. Multiple data sources (including high-level technical reports, key informant interviews, and the peer reviewed literature) were synthesized to gain a better understanding of current implementation strategies, including both the barriers and facilitators of EMR in British Columbia between 2006 and 2010.

Results
There is a lack of formal evaluation by the BC Task Force – the Physician Information Technology Office (PITO). Specifically, approval of vendors has led to a wide variation in EMR costs (e.g., initial investments can vary from $4850 to $9800 for physicians, though 70% of the cost is covered by PITO). The concept of return on investment also remains unclear although as much as  $86,000 may be saved by the health system for each health care provider who uses EMR. Physicians are mainly concerned about office efficiency, liability, decision support and if systems go-down. Cheaper vendors while available remain unsanctioned by PITO. Little formal evaluation either by PITO or Canada Health Infoway has been undertaken, and if done, this information not publically available.

Conclusions
The current process does not work well. It is recommended, based on the available evidence, that PITO needs reform; including commissioning of EMR physician advocates, broader (cheaper) vendor availability, the use of disincentives to prevent non-PITO compliant systems use; and formalizing evaluation processes; the results of which, should be public.