Switch to e-records causing pain for Ontario doctors

Medical clinics and other primary health-care centres in Ontario have been struggling with the transition to electronic patient records, say several industry experts.

An increasing number of physicians, nurse practitioners and a host of other health-care providers have adopted electronic medical record systems in recent years, but there are significant growing pains using the programs – a phenomenon that stretches across North America.

Administration staff at several doctor’s offices in Ottawa say the variety of products available to Ontario doctors each comes with a host of problems, including delayed response times, system freezes and the occasional complete shutdown. Some programs are just not user friendly, which led some office managers to switch to another of the 13 providers in the province. Industry analysts say there is a growing dissatisfaction among clients as more users make the transition to electronic record keeping. This observation was highlighted in Ontario in recent weeks when clients of Nightingale Informatix Corporation experienced delays when a user influx strained the system.

Clients reported slowdowns while trying to access and input records.

“More practices are having challenges with adoption and implementation of electronic medical record systems than are not,” said Thomas Stringham, co-founder and chief executive of Cientis Technologies, a company that created a website where users can rate their electronic systems providers. “Vendors are needing to scramble right now to keep them (customers) happy.”

Nightingale’s system struggled because 1,000 new users were added in the past year, which created delays when thousands of people were accessing the system at once. The company has about 7,500 users in Canada, with about 4,000 of those in Ontario.

A major part of the problem was a massive influx from members of the Association of Ontario Health Centres.

In the past year, the association alone accounted for 925 new users on Nightingale’s system with a large portion coming online in recent weeks.

Association executive director Adrianna Tetley refers to the slowdowns along the way as necessary hurdles to eventually get to a more efficient system.

The elimination of paper “speeds up the transmission of information and greatly improves speeds that test results can be scrutinized and then treatment provided,” said Robert Mitchell, vice-president of communication for eHealth Ontario, the agency set up by the Ontario government in 2008 to help physicians transition to the new technology.

Most provincial governments offer funding to physicians to adopt electronic record systems.

The Ontario government, through eHealth Ontario, contributes on average about $28,500 per physician, totalling nearly $280 million over the last four years.

About nine million patients in Ontario now have electronic records with about 10,000 health-care providers, according to eHealth Ontario.

Making the switch, however, can be difficult. Staff at several clinics in Ottawa are frustrated with the programs they adopted.

Physicians at Riverside Court Medical Clinic recently transitioned to OSCAR, an open source system designed and maintained by doctors and social service agencies in Canada. But Riverside office manager Fran Pallag describes the program as a “brutal” experience.

“We’re still learning how to use it, but it’s not very user friendly,” she said.

“It’s crashed a couple of times, and there have been a few error messages that come up. But I will say, when we’re in a crisis and it goes down, (the company is) pretty quick to respond.”

Once physicians download OSCAR, they can select a provider that will set up the program, select hardware, provide training and maintenance.

Staff in other Ottawa clinics, endorse OSCAR, saying they have no issues.

“The great thing about OSCAR is that you get competitive pricing from providers,” said Dr. Tomislav Svoboda, a Toronto physician who is also both a developer and a user of OSCAR.

“People think because OSCAR is open source, there is no support, but that’s a myth. There’s actually more providers because it’s open source.”

Difficulties with the variety of programs create a great deal of frustration, particularly because the programs are billed as a way to make the health industry much more efficient, according to Stringham.

“Some of the frustrations is, they adopt the systems thinking it’s going to make their lives easier, but then they can’t capture data fast enough during a patient visit,” he said.

Nightingale faced its harshest criticisms recently in Nova Scotia, where there are only two providers of electronic medical record systems.

Doctors there experienced delays last fall, and then came several complete shutdowns starting in December, said Stewart Gray, director of IT for Doctors Nova Scotia, the medical association for physicians in the province.

“Once patients are in the office (and the system crashes), it slows down the process for everyone in the clinic,” Stewart said

Nightingale president and chief executive Sam Chebib said most of the troubles are behind the company, which has fixed many of the issues in Nova Scotia and plans to build a new data centre to double its user capacity.

Stewart recognizes there have been fewer slowdowns, but his members want to see more changes.

“There’s been some improvement, but not enough to please our physician community,” he said.