March 5, 2013, President's Letter

March 5, 2013

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Dear Member:

In this letter:

• As agreed to in the 2010 Electronic Medical Record (EMR) Acceleration Plan, the Physician Office System Program (POSP) will cease to provide physician services by March 31, 2014.
• Alberta Health (AH) and the Alberta Medical Association (AMA) are discussing program wind-down, including what support will be provided to current enrollees; this will be communicated in April.
• POSP is a reimbursement program, but also more than that: it is an important support for office overhead costs that physicians must pay to keep offices open and patients cared for.
• A comprehensive, integrated health information strategy and information system needs a robust network of physician EMRs. Are we risking the investment we have made?

Experience in Alberta and across Canada has shown that EMRs improve efficiency, safety and quality at the point of care. They are also vital to integration of medical care delivery, i.e., seeking the most-efficient ways to deliver care to patients in a seamless continuum from primary to secondary/tertiary care and back again.

The Physician Office System Program was established in 2001. Over the past 12 years, the program has provided financial and transitional support to physicians wanting to adopt EMR technology. A key goal of POSP is to facilitate physician adoption of EMRs and Alberta physicians have adopted them broadly. As of December 31, 2012, POSP reported that 3,422 of a potential 4,400 physicians had implemented an EMR system. This represents an adoption rate of over 77%.

In 2010, AH, Alberta Health Services (AHS) and the AMA established an EMR Acceleration Plan to be completed by March 31, 2014. At the same time, the parties agreed to communicate the intention to continue funding the implementation of approved EMRs until that Acceleration Plan has been completed.

As a result, and as agreed to by the parties, POSP will cease to provide physician services by March 31, 2014. POSP is continuing its operations, completing implementations currently underway and assisting those physicians interested in adopting an EMR.

Discussions are underway between AH and the AMA with respect to steps to wrap-up POSP business, including clarification of what support will be provided to physicians currently enrolled in the program. We expect that further information on this and other important matters will be issued in April.

In our view, the termination of POSP without identification of a replacement strategy is yet another illustration of a health care system that needs thorough planning more than ever – placing the right resources that are supported in the right way and at the right time.

The parties designed and implemented POSP for a reason. It was intended to help develop a thriving and valuable provincial e-health system infrastructure. It was also meant to help physicians deliver better care with all the clinical decision and business support that EMRs can provide. The overall goal was to make health care delivery by physicians and their teams more efficient and effective.

POSP is a reimbursement program, but it is also more than that. It is an important support for office overhead costs that physicians must pay to keep offices open and patients cared for. Community physicians need that assistance. They are working in an environment of health care budgeting constraints, with AH recently warning of reductions in services and programs. With AHS budget cuts, there will be a natural download of institutional care out to community-based physicians, most of whom are already at full capacity.

If EMR support is unavailable in the longer term, it’s another example of asking community physicians to do more by caring for patients who are offloaded to the community, but doing so with fewer resources, higher costs and more stress on their functions as small businesses and employers.

At a system level, a comprehensive, integrated health information system needs a robust network of physician EMRs. Linked to other provincial e-health technology, the EMRs will provide the information needed to reform the primary care system and to help keep patients in the community and out of hospital when that’s appropriate. There is huge value in the evolving primary care networks to improve access and quality.

We know we need better ways to monitor the health of Albertans if we are going to ensure they have access to the health promotion and illness prevention services they need. We need to help patients move seamlessly through the system, particularly if there is a rapid squeeze on AHS and the hospital system that pushes patients out into the community. We cannot do these things without good information and a sound information strategy.

EMRs are part of that strategy and our current level of uptake by physicians reflects substantial investment in dollars and time. If support is not available for physicians to use EMRs, do we risk the investment that has been made so far and the health care system we hope to achieve? I believe we do.

As I write this, we are all aware of the imminent release of the provincial budget on Thursday, March 7. I will write to you thereafter with some specific thoughts on that topic. One cannot help but be pessimistic, as the musing in the media have doctors, nurses and teachers all targets for sniper fire.

I rely on your input and comments. Please comment below or email president@albertadoctors.org.

Regards,

R. Michael Giuffre, MD, MBA, FRCP, FRCPC, FACC, FAAC
President