Talking to Dr. Tim Kolotyluk about cybermedicine is like running beside a freight train. You can't keep pace with his enthusiasm.
Kolotyluk, a 53-year-old family doctor in Westlock, just north of Edmonton, wired his clinic in 1998 knowing electronic health records were the way of the future. Today, Kolotyluk is one of 2899 Alberta physicians who have benefited from the Physician Office System Program (POSP), a government incentive to encourage office automation.
Kolotyluk and his 3 clinic colleagues have computers and printers in every examination room, 2 servers, voice recognition software, an information technology expert on call and a staff freed of paper files.
“You can no longer say, ‚I don't like computers.' Our patients are leading the way with questions about the Internet,” says Kolotyluk. “They have said, ‚Come along with us.'”
The 5-year-old incentive program, which has cost taxpayers about $70 million so far, offers physicians up to $35 520 in monthly installments over 4 years, a sum intended to cover 70% of the cost of hardware, software and networking. Physicians are expected to pay the remaining 30%.
Roughly 53% of practising physicians have incorporated information technology into their practice in Alberta, the highest rate in Canada. Of those, more than 80% are currently using or converting to electronic medical records.
The Alberta Medical Association maintains doctors gave up about 1.5% in fee increases during contract talks in 2001 to designate money to the program. They could perhaps afford the sacrifice: Alberta physicians negotiated a 22% increase over 2 years in 2001, making them some of the highest paid medical professionals in the country at the time.
Oil-rich Alberta may have more discretionary spending than most provinces, but proponents say it's the innovative structure of the program, not just the dollars, that won converts — a structure they say required insightful leadership and compromise from physicians, government officials and, later, the health regions.
Dr. Fraser Armstrong, an Edmonton physician and co-chair of the AMA's POSP committee, explained the program's cornerstones:
• Vendor Conformance and Usability Requirements: a set of technical requirements against which technology vendors' products are conformance tested. Physicians must choose products that are VCUR-certified in order to get funding.
• Change management: The program provides management services through a network of private sector resources and physician mentors dedicated to helping physicians convert from paper to electronic records.
• Privacy Impact Assessment: Physicians are required to submit an assessment to the province's Information and Privacy Commissioner outlining how they plan to protect patient information.
Armstrong is excited about the seemingly limitless opportunities computer technology affords doctors and patients: diagnostic tools that flag patient files for things like drug interactions, allergies and mammograms; efficient transfer of lab results and patient hospital reports; and easy access to complete patient files for clinic colleagues.
“I think we're stepping to a new level,” he says. “We'll look at the patient differently than we ever have — more comprehensively.”
The program has created a national buzz, especially in provinces struggling to establish electronic record-keeping. “Alberta has the best program I've seen and I've looked into the United States as well,” says Bill Pascal, the Canadian Medical Association's chief technology officer. No province, no matter how financially challenged, can afford to ignore cybermedicine, he says. Electronic records save government money in the long run and help doctors deliver better, more comprehensive care.
Mark Dermer, senior medical advisor for Canada Health Infoway, calls the program revolutionary and groundbreaking. “It was the first time a jurisdiction recognized the need for financial assistance to physicians working in private offices,” he says. Expecting physicians to pay for equipment, support and transition is “fundamentally unfair.”
Infoway, a not-for-profit agency comprised of Canada's provincial and territorial deputy health ministers, promotes the use of efficient health information systems by funding innovative projects, end-user education and by establishing national, inter-operability standards.
While the Alberta government, the AMA and the health regions hammer out the next phase of the program, which could extend funding to 2008, policymakers continue to debate larger questions of overall system security, patient confidentiality and database usage. Electronic medical records offer a plethora of research possibilities and just as many potential controversies. For now, secondary use of that database is considered off limits. — Lisa Gregoire, Edmonton
Figure. Roughly half of practising physicians have incorporated information technology into their practice in Alberta. Photo by: Photos.com