Interoperability for Electronic Medical Records in Canada
Brad Lawther
CEO and Founder
Cybermedex Inc.
Over the past decade, Canada has witnessed a consolidation of the EMR market that has effectively halted innovation and competition within an already stagnant market. The result is a healthcare system where corporate profits have been prioritized. More than 90% of the EMR market is controlled by 3 corporations, spread across about 13 different EMR products.
Physicians have had no influence over this consolidation, and many are left as customers of corporations which do not align with their values. Physicians have patient data which is now locked to these corporations, as interoperability has not historically been a priority for vendors. In many instances, there are data export penalties levied by these corporations intended to financially disincentive switching to more modern platforms.
Interoperability is the key to unlocking patient data trapped within legacy systems. It enables the movement between different EMR systems, and allows for competition to be the driving force behind innovation.
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There are a few scenarios where data export and interoperability capabilities are important:
- Closures: clinics close for numerous reasons. When a closure does occur, what happens to patient data? My community recently lost a wonderful physician. She closed her clinic in order to move to another province. However, many of her patients have been left without access to their records. With no phone number to call or contact information, these patients have been left hanging with no clear way to receive a copy of their information.
- Group change: when more than one physician forms a group to provide care under a single clinic name, one or more members of this group may leave. When this happens, how is that patient data managed? The 'Custodianship of Records' should have already been negotiated at the start, however in some cases the departing physician is the authorized custodian. In this case, how should patient records be transferred to that custodian? The custodian has a legal duty to ensure that data is stored in compliance with both federal and provincial requirements. In the case where the clinic remains the custodian, priority should always be patient safety and well-being in order to avoid delays in diagnosis or treatment. Many EMR vendor impose licensing agreements which require that any physician who has access to a system must pay a monthly (or annual) fee. This can add an unnecessary financial burden to the clinic, especially for clinics with high turnover rates.
- System change: it's not uncommon for clinics to change ownership. This is often a time when EMR systems are reviewed and changed. Clinics will also decide to upgrade their legacy EMR to a more modern platform to increase efficiency or to reduce administrative burden. Anytime a clinic decides to change systems which contain patient information, all that data must transfer to the new system and staff must to trained on how to use the new software
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According to a study by RAND Corporation, lack of interoperability among health IT systems is one of the major barriers preventing improvements in healthcare delivery (RAND Corporation, 2018). Furthermore, Canada Health Infoway reported that only 47% of Canadian physicians use EMRs with advanced functionalities (Canada Health Infoway, 2020).
For the past 7 years, Cybermedex has dedicated a significant amount of time to migrating patient data from multiple vendors onto our platform. We never charge for data exports, so once a customer migrates onto our platform, our data export capabilities allow patient data to be downloaded in a number of different formats (including Microsoft Word documents) anytime and without cost.
Our goal is to open-source this data migration and export technology, and expand its scope to include data connectors for every major EMR system in Canada. The Canadian healthcare system cannot afford to wait for a few profit-driven corporations to solve this problem, it's simply not in their financial best interests to do so. At Cybermedex, we prefer to compete with other EMR vendors based on price, service, and innovation. We’re also actively supporting local and federal governments to enact legislation against data export fees.
We must act now before a few corporate giants take control of our healthcare system. Please add your name to this campaign, and help us bring about much-needed change in our healthcare system. With your support, we’re seeking funding from a number of federal and provincial organizations to create a not-for-profit and open-source service that leverages our technology for the benefit of all Canadians.