- © 2008 Canadian Medical Association or its licensors
A recent editorial by Ken Flegel repeats the purported advantages of keeping electronic medical records.1 The results of the electronic conversion of paper records in other industries suggest that such a conversion in medicine will be a boon to patients, payers and providers. Surprisingly, however, there is a paucity of trials measuring the benefits of introducing electronic medical records.2
The best study, conducted in Montréal, found that physicians and nurses needed considerably more time for electronic than for traditional medical record-keeping.3 A small office-based study found that it took about an extra one-half clinic day per week to keep electronic medical records compared with paper charts.4 On a positive note, a systematic review found that the need for repeat investigational interventions and drug use decreased in a primary care setting with the use of electronic medical records.5 However, the main effect reported in this US study was an improvement in the billing profile of the physicians who used it. Other researchers have questioned whether the widespread introduction of electronic medical records will save money.6
What is clear is that the current proposals by Canadian payers (the provinces) to support physicians who adopt electronic medical record- keeping fall far short of what is needed. It is informative to look at countries such as the Netherlands, where the penetration of electronic medical records is greater than 98%: not only are all hardware and software costs completely reimbursed, the remuneration system has been changed from a simple fee-for-service system to a blended scheme that reimburses physicians for the extra time needed to keep electronic records. In addition, hospital-based call centres have been supported, which are manned by community-based physicians who rely greatly on the electronic medical records for one another's patients.
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Competing interests: None declared.