Five reasons your family doctor isn’t using EMR

An EMR vendor, group physician and OntarioMD weigh roadblocks to electronic medical record adoption for family physicians

Roughly 30 per cent of family physicians in Ontario utilize electronic medical records (EMRs), according to OntarioMD Inc., a subsidiary of the Ontario Medical Association (OMA) funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC).

OntarioMD recently completed phase one of its Physician IT project, which provided EMR funding to 3,000 out of an estimated 10,500 family practitioners in Ontario.

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"It's about 30 per cent," said OntarioMD CEO Brian Forster. About four million Ontarians would be covered by those emergency medical records, which is approximately 25 per cent of patients, because roughly one million patients in Ontario don't have family physicians, he explained.

Despite recent funding scandals related to eHealth programs in Ontario, OntarioMD exceeded its target for the $150 million it received in government funding, noted Forster.

"The initial program we've executed over the last four years had a limited amount of funding. That funding was actually targeted at 2,900 physicians, but we were able to fund 3,000 because of the way we were able to optimize what we've done during those four years," he said.

OntarioMD is currently in discussions with eHealth Ontario, which is now responsible for a number initiatives from the Ontario Ministry of Health and Long-Term Care, for funding that will support the next phase of the program over the next three years.

Under the old program, which expired in August 2008, physicians were eligible for a maximum $28,600 to implement an EMR system. "The new number hasn't been finalized at this point and once it has, which we are hoping will be shortly, it will be announced," said Forster.

But there are still obstacles to widespread adoption.

Cost and funding

Cost is still the major obstacle to EMR adoption for physicians, according to Dr. Stephen McLaren, a family physician based in Markham who belongs to an 18-physician group that began developing an EMR system in 1998.

The funding that was sent out was only partial, he pointed out. "It does not completely pay or continue to pay for what you need to do, so it's nice to receive that partial funding, but I don't think we should mix it up with it being complete funding because it's not," said McLaren.

Physicians looking at EMR realize there are a lot of costs outside the funding envelope, so they are going to have to make a business case for it, he said. "For some people, they find it a difficult business case to make, although in our case, we live the value of EMR and it has been a very good investment for us," he said.

Another problem lies within the old funding model itself, according to McLaren, because it went to two different styles of practice and physicians had to align their offices with a payment scheme in order to receive the funding.

"So there's two change management pieces that happen at once," he said. "I'm not sure if in the second round of funding they will remove that obstacle or not," he said.

Limiting funding to family physicians has contributed to interoperability problems, such as a lack of intercommunication between family practices and specialists, according to Moshe Pinhas, president of Toronto-based clinical management system software provider P&P Data Systems Inc.