Electronic medical record use halted in Nova Scotia hospitals

Nova Scotia's Department of Health and Wellness is pressing pause on the number of doctors who can use electronic medical records (EMR) in provincial hospitals, a move Doctors Nova Scotia says could deter doctors from logging on in the future.

The Department of Health issued the directive after the nine health authorities merged into one in April.

The policy directive doesn't apply to doctors who have already been approved to use electronic medical records and physicians practising outside of hospitals.

It makes physicians' care for patients less efficient.- Dr. Michael Wadden

"It needs to be quickly and reasonably figured out...It makes physicians' care for patients less efficient," said Dr. Michael Wadden, a family physician in Kentville and chair of the Doctors Nova Scotia IT Steering Committee.

"If you're a surgeon caring for one of your patients after surgery it would be a lot more difficult to access your office notes you made prior to the surgery...It puts a lot of doctors in limbo and caused quite a bit of anxiety."

Tony Kiritsis, a spokesperson for the health department, said they found there hasn't been a consistent approach toward electronic records inside hospitals. Some hospitals used electronic records, while others didn't for medical and legal risks.

Shadow chart concerns

"Before we can enhance the EMR, we are looking at ways we can have a consistent, provincial approach with a fully integrated system," he said in an email.

There are three approved electronic medical record programs in Nova Scotia, but some specialists use other ones. The programs collect patient information including medical history, medications, immunizations and allergies. They allow doctors to instantly access patient information.

One of the main issues, according to the directive, are shadow charts and other charts outside the authority's control. For example, a surgeon might keep a record on a patient at their private clinic, outside of the hospital system.

"Once installed, there is no way to limit, monitor or prevent the full use of the EMR," warns a ministerial briefing note obtained by CBC News.

According to the health department, about 70 per cent of family physicians and 43 per cent of community-based specialists use electronic medical records.

The government has shown it wants those numbers to be higher.

The province has offered $31.5 million in incentives to entice doctors to adopt an electronic medical record system.

Doctors Nova Scotia says it's concerned the directive will deter doctors from adopting the record.

A 'disincentive' 

"Our biggest worry is by pausing this and telling physicians they can't use their EMRs in hospitals, some physicians may not adopt an EMR who were thinking about adopting an EMR," Wadden said. "If you're told you can't use it 50 or 60 per cent of the time, if you're a surgeon it would make you pause and think [about] if you want to put the financial investment into that."

He says it costs about $40,000 over the first four years to install an electronic record system and train staff.

"They're not really saying don't adopt EMRs. They're saying we can adopt them — we just aren't going allow you to use them in the hospitals. So if you do any amount of work in a hospital setting, you can easily see where that would be a disincentive to you," he said.

Wadden said the move also means it will take longer for hospital physicians to bill patients.

Doctors Nova Scotia says the deputy health minister has agreed to talk about the directive, but they haven't pinpointed a date.

Since 2004, the province has spent $37 million to establish electronic medical record services.