Electronic Medical Records Feed Electronic Health Records
Electronic Medical Records the EMR
The BC government is subsidizing physicians costs to change from using paper medical records to electronic medical records (EMR) systems on the condition that portions of their EMRs will be made available to a centrally-managed Electronic Health Record (the IEHR) that will be interoperable with other systems across Canada.
The BC government has entered into an agreement with the BC Medical Association to fund the Physician Information Technology Office, (PITO), which provides financial and technical assistance to doctors who agree to use specified software companies and off-site storage systems linked to the provinces iEHR system, and who agree to have their patients information automatically uploaded to the EHR system.
The information to be uploaded by the BC government from the doctors electronic medical record to the province-wide iEHR is referred to as the Core Data Set. Each identified individual patients Core Data Set includes:
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demographic information;
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current conditions;
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past medical and surgical history;
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allergies/alerts; current medications;
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immunizations;
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advance directives; and
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most recent and critical diagnostic data.
The Core Data Set may include the patient's most sensitive and revealing personal health information. And once the systems are built, extraction of the patients personal health information from the physicians EMR to the province-wide iEHR will be automatic, and done on a routine basis.
Interoperable Electronic Health Records the iEHR
The primary purpose of the iEHR system is to make patient data accessible to other health care providers such as other doctors, therapists, pharmacists, physiotherapists and dieticians. The government of BC says that a health providers access rights will be based on his or her role, but it seems clear that they all could have access to the Core Data Set. Unfortunately, as of March 2009 the details of how this roles based access will actually work has not been defined.
The other main purpose of creating the iEHR system is to enable more efficient healthcare system planning. For this purpose, aggregated (e.g. compiled and anonymous) information from individual health records will be used to analyze how the whole health system is being used, to better understand health outcomes for people and minimize costs to the system. In addition, the iEHR will facilitate the gathering and distribution of health information to researchers for research purposes.
Critics argue that the province has not really even begun to address the privacy rights and protections that should be engaged when personal health information is used for these secondary purposes. Questions such as how and when personal health information is made anonymous, when it can be used in an identifiable form and how access to it is managed are not fully developed yet. Nevertheless, the systems are well on their way to being built.
The province is promising that patients will have the ability to put disclosure directives on their health records so that their information is not readily accessible. But it is not at all clear at this point how this will work. Will an individual will be able to put the disclosure directive on their health record at the level of the particular treatment, prescription or physician name, or will the disclosure directive have to be on the whole record, thus effectively requiring the patient to make an all or nothing choice. That is unclear.
Furthermore, the e-Health Act sets out the broad requirements for disclosure directives, but it is not at all obvious that the average citizen will be able to figure out how to put a disclosure directive on his health record, which makes a disclosure directive of limited usefulness.
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