Patient care in the information age

I found the exchange following the letter “Time to rethink EMRs [electronic medical records]?”¹ interesting.^2,3 My experience in Halifax, NS, with an electronic medical record has spanned 12 years, with 1400 patients and up to 30 medical office assistants. In 2013, my clinic successfully pilot-tested a personal health record that gave online access to booking, consultation, and release of imaging and other diagnostic results to patients,⁴ and I was able to increase my capacity for care by 22%. (I suffered a self-imposed loss of 18% to my earnings. I believed the personal health record had to be test-driven to its full extent, and as the remuneration for the work was a stipend, I consciously incurred this expense.⁵)

There is no question that the introduction of technology and automation to the family doctor’s office has both positive and negative effects. End users—be they doctors, patients, or staff—have diverse skills in the use of technology, so an effect on care and outcomes is to be expected. Attrition is also to be expected. These tools are limited by many issues that are yet to be worked out. However, the gains, when realized, are irreplaceable. Their value and effects are immeasurable. Activation and engagement of people in acquiring and understanding information about their bodies and behaviour is yet to be captured with our “evidence-based tools.” The outcome-based presentation of e-health effects often does not capture elements that are relevant in the actual field of practice. New tools, such as geographic information systems, are necessary to capture the complex effects of such interventions longitudinally.

It is important to capture feedback about all aspects of e-health tools and pull together the picture that is evolving. Through iterative methods, we can then intelligently address the gaps, losses, and unanticipated harms that will emerge. We cannot afford to overrule or silence any such feedback by presenting “evidence” as the literature presents it. After all, what happens in the real world of the healing arts is contingent upon the relationships between the healers and the people who choose to engage with them.

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