EMRs swift to pinpoint prevention, follow-up care

TORONTO – Primary care practices with electronic medical records identified patients who need preventative or follow-up care approximately 30 times more quickly than paper-based clinics, according to a study commissioned by Canada Health Infoway, a not-for-profit organization funded by the Canadian government.

Researchers from St. Mary's Research Centre, MedbASE Research and McGill University challenged participating clinics to review their patients' records to identify those who would benefit from six different types of evidence-based interventions: immunization, follow-up care after a heart attack, cancer screening, diabetes management and two medication recalls.

[See also: Canada puts up $380M to help docs with EMRs]

"These results demonstrate the value of EMRs in enabling clinicians to deliver high-quality patient care in a timely fashion," said Richard Alvarez, president and CEO of Canada Health Infoway. "The good news is that the number of family physicians using EMRs has grown significantly in recent years, improving quality of care and supporting more efficient care delivery in practices across Canada."
 
Practices using EMRs reviewed the records of all their active patients in an average of 1.4 hours. Paper-based practices of approximately the same size reviewed 10 per cent of all active charts in 3.9 hours, which means that they would have needed an estimated 40 hours to conduct a full practice review.

Practices with EMRs were also more confident in their ability to contact all the right patients to receive the appropriate treatment or intervention in a timely manner. On a scale of one to five, where five is very confident and one is not confident, EMR-based practices were more confident in their reviews than paper-based practices (average score of 3.8 vs. 1.9).

"Using an electronic medical record gives me the peace of mind of knowing I can more quickly identify patients who would benefit from immunizations or other preventive care, as well as those who might be impacted by events such as a medication recall," said Michael Golbey, MD, family physician and chair of Canada Health Infoway's Clinical Council. "Studies such as the practice challenge demonstrate the clinical value that electronic medical records can deliver across Canada."

The basis for the Practice Challenge is an approach to primary care called practice-based population health management. It uses information to help improve care and clinical outcomes across the patients in a given practice. This can include common tasks, such as helping patients with hypertension to manage their condition, or less frequent yet critical tasks, such as a medication recall where timeliness is essential, study officials said. This approach to care has been cited by the College of Family Physicians of Canada as a key element in the transformation of primary care and can help primary care practices to continuously review their services and improve the quality of care that they provide.
 
It is also an approach that Canadians are seeking. In a 2012 Harris Decima survey, 73 per cent of respondents agreed they should receive reminders if preventive or follow-up care is recommended because of their age or health problems. Most of these individuals (85 per cent) indicated that reminders should come from their family doctor or regular place of care.

[See also: Canada launches fight against chronic disease.]

About the challenge
Eleven community-based primary care clinics, including 21 individual physician practices, took part in a one-day Practice Challenge. Seventeen practices used EMRs while four practices used paper-based records. The clinics are located in British Columbia, Ontario, Quebec, Nova Scotia and Newfoundland.
An expert panel of family physicians identified six evidence-based interventions from which specific types of patients could benefit. For each, practices were asked to identify patients in their practice who qualified for that intervention. Those who did not complete the chart review by a set cut-off time recorded the percentage of charts they had reviewed.

The study is a part of a series aimed at understanding the value of EMRs for physicians, patients, and the health system as a whole. Each study is undertaken by academic researchers from across Canada, with support from Canada Health Infoway.