Iris Gorfinkel is a General Practitioner, and Founder and Principal Investigator at PrimeHealth Clinical Research in Toronto, Ontario.
Medical documentation in primary care is a balancing act between promoting timely connection with patients and reducing clerical demands placed on physicians. Clinical notes contain increasingly less by way of narrative. They are often made up of time-saving digitized checklists of symptoms, physical findings, and treatments. Or the progress note may be a copy-and-pasted template. Both checklists and templates lessen the need for clinician typing and offer detailed notes within a few clicks.
Prior to the electronic medical record (EMR), hand-written or dictated notes would often relate a patient’s experience by quoting patients' descriptions of their symptoms. With the arrival of the EMR, doctors, most of whom had little typing experience, were abruptly confronted with having to type detailed patient encounters. The degree to which a clinician must type has since been correlated with physician burnout, which has risen sharply in conjunction with EMR utilization. ...continue reading →
Kirsten Patrick is Deputy Editor at CMAJ; she's currently attending the 31st International Conference on PharmacoEpidemiology &Therapeutic Risk Management (ICPE) in Boston
About a year ago I suggested "Big Medical Data" as a potential topic for a CMAJ editorial to our editors’ writing group. I remember receiving some blank looks that sounded a lot like “Weirdo!” In fact, that may well have been upon my return from the last ICPE, or perhaps it was a year before that when I came back from participating in the working group that produced The REporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) Statement. Anyway, there’s something about talking to people who are working with, and developing new ways of crunching, Big Data that gets me all fired up about it. I can see an exciting future full of possibilities and I want to evangelize.
In the first plenary session at ICPE yesterday, entitled “Computer Power and Human Reason: from calculation to judgement”, speakers seemed to be defending the role of the pharmacoepidemiologist now that crunching data with computer programs can tell us just about anything we need to know. What are the virtues of the human operator vs. computer systems? “Is it the pilot or the plane that’s critical for a successful flight?” ...continue reading →
Sudhir D'Souza is a semi-retired paediatrician practising in Ontario
“About 80 per cent of health data is captured in physicians’ offices. Electronic records connected to hospitals and provincial health databases will provide a comprehensive and secure picture of a patient’s health.”
Greg A. Reed, Former CEO of eHealth Ontario
What happens when you leave a clinic? Do you remain the ‘health information custodian’? Do the electronic charts move with the patients who follow you?
In January, I decided to leave a ‘turnkey’ clinic and start my own practice. To accommodate patients for whom location was paramount, I allowed my electronic practice records housed in a server located in my office to be amalgamated under an Application Service Provider (ASP) EMR – cloud based – with the rest of the physicians in the clinic space we had shared. ...continue reading →