EMRs and Empathetic Patient Care

Contributed by OntarioMD Peer Leader Dr. Yves Raymond

Recently, Newfoundland physician Dr. Thomas Hall contributed an opinion piece to CanadianHealthcareNetwork.ca, the online home of The Medical Post. Hall’s article – which can be read here (if you’ve registered for a Canadian Healthcare Network account) – argued that while EMRs are useful for connecting health care databases and analyzing patient data, using them during patient encounters risks the doctor being seen as distracted and lacking empathy.

I commented on the website that I find it interesting that we’re quick to blame technology when, in fact, it is how the user chooses to use the technology that is the real issue. In my comment, I also took the liberty to rewrite Dr. Hall’s article substituting paper charts for EMRs as evidence that his arguments could still be made if the medium were paper rather than EMRs. My version is below. Leave a comment below this post to let us know your take on this important issue.


Paper charting no doubt helps remember what you did, but what do they do to the more subjective nonverbal parts of our patient encounters in office?

Over the last number of months, I have been talking with both psychiatry colleagues in Newfoundland and with staff at the British Columbia Psychiatry Association about their thoughts on paper charting in a family physician’s office. Generally, they felt, and I agree, that paper charts in a physician’s private office as a place to write notes after an undistracted face-to-face patient encounter is potentially helpful. However, in my informal conversations with these physicians, they all expressed serious concerns about the possibility of being distracted and the perceived lack of empathy that may arise from their use of paper charts in the office while examining a patient. This is a serious problem, as most family physicians use paper charts in their exam rooms while seeing patients.

Also problematic is that a family physician’s day is approximately one-third to one-half filled with some components of psychiatric care. I often ask physician colleagues the question: “What do you think of a patient who checks their agenda during their appointment?” Almost exclusively physicians answer with words such as annoying, wasting my time, rude, or with even more intense expletives. This is just a normal human reaction when we think our time is being wasted or we’re not being taken seriously. We physicians have to be aware that the reverse is also true for patients who perceive similarly in encounters where the physician is constantly looking at and writing notes into a paper chart.

Apart from the obvious perceived lack of caring and empathy that paper charts in patient rooms may exacerbate, there also should be serious concerns about what a physician might miss by being distracted by writing notes into a paper chart. A small enlargement of one side of a patient’s neck, clubbed nails, thinning hair, a small facial droop, a facial expression crying out for help from a patient’s partner sitting across the room, etc. These subtle things will undoubtedly be increasingly missed as physicians are pressured to enter more notes that often serves no purpose other than liability coverage and administrative information.

Paper charts will eventually be in every physician office in the country but the “leaders” in our profession, who are often too removed from complicated day-to-day front-line patient care, need to be more proactive about policies that will minimize these pitfalls. As an example, here is some advice from Nobel Prize winner Dr. Lown, author of The Lost Art of Healing:

“Healing is replaced with treating, caring is supplanted by managing, and the art of listening is taken over by technological procedures … Doctors of conscience have to resist the industrialization of their profession.”

Could rules be established by medical associations to suggest paper charting use be reserved to outside patient rooms? This would also require a potential increase in physician remuneration to manage the increased work that would result from extra notes entry at the end of the day.

London EMR Every Step Conference 2018


OntarioMD’s EMR: Every Step Conference in London on April 12, 2018 will feature 11 sessions designed to inspire and educate clinicians on how to get more clinical benefits from their EMRs. These sessions have been certified by the College of Family Physicians of Canada’s Ontario Chapter for up to 7.5 Mainpro+ credits.

To see the full conference schedule and register, please visit https://www.ontariomd.ca/about-us/events/emr-every-step-conference-london-2018

Here is a glimpse of what you will learn at some of the conference sessions:

Pain, Opioids and Your EMR

Presented by Dr. Gordon Schacter, London Middlesex Clinical Lead, South West Local Health Integration Network 

  • A basic understanding of the issues in pain and opioid prescribing
  • Knowledge of the minimum standards for assessment and management of pain and opioid prescribing
  • How EMR tools can facilitate your ability to meet those minimum standards for assessment and documentation
  • All the pain and opioid resources that are available to you: Self-Management, OntarioMD Peer Leaders, OCFP Mentorship, etc.)

EMR: Making Data Quality and Data Mining Exciting

 Presented by Dr. Mario Elia, OntarioMD Physician Peer Leader

  • The importance of high-quality data integrity
  • An easy-to-use framework for clinical effectiveness in primary care across multiple domains
  • Practical advice for moving forward with improving clinical data work in your office

Overcoming Wait Times for Specialists Using eConsult

 Panelists: Dr. Anil Maheshwari, Chief of Family Medicine, Cambridge Memorial Hospital and OntarioMD Physician Peer Leader, Dr. Harpreet Arora, Board Member, Grandview Medical Centre, Dr. Sunjay Gupta, IT Physician Lead, Grandview Medical Centre

  • Which types of issues are appropriate for eConsults
  • The advantages (and disadvantages) of eConsults
  • The steps taken to get both primary care physicians and specialists on board
  • The actual referral process, the wait times for eConsults, the feedback from patients, family doctors and specialists

Switching EMRs: Lessons from the Front Lines

Presented by Dr. Stephen McLaren, OntarioMD Physician Peer Leader

  • How to successfully transition your practice from one EMR system to another
  • Best practices for data migration
  • Other tips and tricks

Select your Agenda and Register



Journalism in the Twitter Age: How Health Care Partners Can Help Shape Stories

Contributed by Hinna Hatif and Neil Faba, OntarioMD Communications and Marketing 

As communications professionals with journalism backgrounds, we’ve both had a front-row seat to rapid change in the industry. In our case, we’re also focused on the changes that digital health has brought to the health care system. From the advent of online media to social media’s proven ability to put storytelling in the hands of those directly involved in the stories, the media landscape has shifted significantly over just two decades.

Twitter, Instagram and other social media platforms are shaking up many other industries, too, including health care. Today, many physicians and other health care professionals are active social media users, portraying their passion for the industry and its advancements in patient care via photos and videos, posts and tweets.

To better understand the way digital and social technology is shifting traditional and digital health care as well as journalism, we recently attended a panel discussion titled Healthcare Journalism in the Age of Twitter, hosted by Longwoods Publishing as part of their Breakfast with the Chiefs series. The panel included two journalists representing different generations and media institutions: Andre Picard a reporter and health policy columnist at The Globe and Mail for more than 30 years; and Rachel Browne, a Senior Reporter at Vice News who’s just a few years into her career. The discussion was moderated by Judith Jones, a patient advocate and communications specialist who was the keynote speaker at OntarioMD’s EMR: Every Step Conference last fall in Toronto. Andre’s name is almost synonymous with health care on Twitter, with more than 70,000 people following his account @picardonhealth.  Rachel, who covers a broad range of health and other topics, is also a very active user as the author of more than 10,000 tweets on her account @rp_browne.

The discussion started out with some thoughts on how news agencies are faring in this changing landscape, while faced with cutbacks, financial pressures, and increasing competition to capture people’s attention. While The Globe and Mail and Vice Media have different histories and cater to very different audiences, the two journalists on the panel agreed that they share a lot of commonality when it comes to their struggles In the face of these challenges.

We’re living in a time where we have near instant access to more information than ever before. On the other hand, we’re barraged by fake news and incorrect information that is sometimes even reported by reliable news outlets because of the competition and demand the 24/7 news cycle brings.

“For people who know how to use the media, it’s the greatest time in history right now,” commented Andre Picard. “You can get everything you want and more. For those who are not interested, which is a growing segment of the population, it’s a waste land of fake news. It’s a dichotomy that’s troubling that one group is getting much larger and the other group is not.” As chilling as this sentiment seems, Rachel Browne offered a glimmer of hope: “there is a strong desire now more than ever for good quality content that’s different, that’s approachable, that’s informative, that’s going to stay and inform the reader beyond just reading the article, and maybe even inform policy decisions.”

Both Andre and Rachel agreed that for the public to get accurate, good quality information from media outlets – particularly when it comes to important subjects like health care where people’s lives literally hang in the balance –  journalists need to be able to get their hands-on quality data on key issues like the opioid crisis. But this is often difficult, or – in the case of opioids where few reliable national stats exist – impossible.  Rachel and Andre advised the audience – comprised mostly of members of the health care industry – to work closely with journalists, PR people and others to help fill in the gaps and tell the stories that need to reach Canadians.

The panellists offered some useful tips on how health care communicators and industry leaders could work collaboratively with journalists to help share information that can drive policy decisions:

  • Form collaborative working relationships with journalists, to understand what issues are on their radar. Many large media outlets have project editors, who can share which topics are being considered for long-term reporting projects and can help organizations understand how they can help shape the story;
  • Understand media outlets’ different audiences, and tailor pitches accordingly. With so many news outlets focused on specific target audiences, understanding how different media focus their reporting can help you tailor your messaging;
  • Facilitate journalists’ access to patients who are willing to tell their health care stories, to add a human face to the issue. At the same time, it’s important that communications people prep those patients so they understand the extra attention they may receive by sharing their experiences.

To listen to the whole panel discussion, please click here.



EMR Tips Video Series

Contributed by Dr. Adam Stewart 

Dr. Stewart has started a series of videos, hosted on YouTube, that show tips on how to use TELUS PS Suite EMR more effectively and efficiently.

The goal is for each short video to be approximately 2-10 minutes in duration. The topics will range from basic to advanced concepts.

Check back frequently for new additions!

Prescription End Dates – Turning On The Feature


Writing Prescriptions – Using End Dates



Writing Prescriptions – Tip Regarding Tablet Strength


Prescription Favourites – A Huge Time Saver

Focus on eConsult: One Physician’s Experience

Contributed by Dr. Anil Maheshwari, Grandview Medical Centre Family Health Team

It’s no secret that wait times for specialists are an issue throughout Ontario. Depending on the area of the province and type of specialist sought, wait times can range from a few weeks to more than a year. Sometimes family physicians will even need to recreate a consult request during the wait for a specialist because it’s been so long since the initial request was made! This is frustrating for both the physician and the patient, and it’s certainly not considered good patient care.

Fortunately, the Provincial eConsult Initiative is helping to shorten specialist wait times by connecting primary care providers and specialists to one of the two eConsult services available. You may be thinking “That’s awesome! But, what exactly is an eConsult?” An eConsult allows a primary care provider to send a secure electronic request for advice to a specialist, including any files needed to support the request. The requesting clinician can select a specific specialist listed in the eConsult database, or simply select one of over 100 specialties and be connected with a specialist.

eConsults have been available in Ontario since 2009. The service offers primary care providers access to more than 500 specialists in over 100 specialties, and an average response time of about two days. Our clinic has been using eConsult since last year and find it to be a huge time-saver. Several of our FHT doctors have used eConsult, and together, have sent over 20 eConsult requests, mostly for advice on dermatological issues (it’s very easy to send a picture) and to specialists such as psychiatrists and gastroenterologists who often have long wait times for face-to-face patient visits.

So, what types of consults make for good eConsults? In my experience, interactions that don’t need to be face-to-face are best suited for an eConsult. For example, primary care providers will often have a quick question for a specialist. While some of these can be handled through phone calls or ‘hallway consults.’ the specialist does not get paid for his or her time and these consults are often not properly documented. eConsults allow the same questions to be sent securely via a web portal, and soon directly through your EMR, and responses can be sent back securely to be attached to the patient’s chart in the primary care provider’s EMR. The family doctor gets a nominal fee for taking the time to create the eConsult, the specialist gets adequately reimbursed for writing out an opinion, and the information is recorded in an electronic format for easy filing.

When I gave a presentation at the OntarioMD EMR: Every Step Conference in Toronto last fall, an attendee asked how the Canadian Medical Protective Association (CMPA) feels about eConsults. The organization has summarized its position in an FAQ document, which was recently updated to clarify physician and specialist responsibilities during an eConsult. In summary, the CMPA supports eConsult as a method to improve efficiency, reduce wait times and ensure a clear audit trail of requests and advice given.

Perhaps most importantly, eConsult holds many benefits for patients. Sometimes, while a patient’s family doctor may be confident in their opinion on a medical issue, the patient would like reassurance and a second opinion from a specialist. Often, these patients are satisfied with getting that specialist opinion in writing rather than having to personally visit their office. In this way, eConsults can help put patients at ease, while decreasing the need for face-to-face specialist visits and associated wait times. Access is increased for those patients who absolutely need to be seen in person.

In my experience, eConsults have been a win-win for everyone involved. If you need more advice, ask some of your colleagues – many have probably tried eConsults. Then, if you’d like to give it a try, get in touch with your OntarioMD Practice Advisor or OntarioMD’s eConsult team at eConsult@ontariomd.com to start the process.

I will be presenting at the upcoming EMR: Every Step Conference in London on April 12 on Overcoming wait times for Specialists using e-Consult. Register today at https://www.ontariomd.ca/about-us/events/emr-every-step-conference-london-2018

Shared Experiences in Digital Health: Visit by the Norwegian Minister of Health and Care Services and Delegation to OntarioMD

Contributed by Sarah Hutchison

On January 24, OntarioMD had the honour of welcoming Norway’s Ambassador to Canada, Her Excellency, Mrs. Anne Kari Hansen Ovind, and the Minister of Health and Care Services, Mr. Bent Høie and his delegation, to our office. The purpose of the visit was to discuss common themes in digital health faced by Norway and Ontario, and how lessons learned in both jurisdictions can impact how we enable system priorities, leadership, and innovation looking forward.

The Norwegian delegation was very interested in learning about OntarioMD’s success in implementing electronic medical records (EMRs) in community-based family physician and specialist practices and how successes with EMR integrated products and services align with Ontario’s Patient’s First Digital Health strategy and priorities. While there will always be more to do, these products and services are already leading to a more connected digital health system in Ontario given the strong and connected foundation that they now represent.

We talked about the critical success factors and methodologies used to deploy products and services to physician practices. OntarioMD’s engaged EMR vendor community and our EMR Certification Program are key enablers for digital health and have created a very valuable mechanism to translate health system priorities using EMR Specifications, into EMR functionality that drives EMR use by physicians. Other   partnerships have also led to the success of our work. There are many organizations that want to deploy their products to physicians but reaching the diversity and range of physician practices across the province is a challenge.  There is increasing recognition that to be more effective as a system we must make it easier for physicians to adopt technology, being very attentive to minimizing the administrative burden for physicians and minimizing disruption at the practice level which means a responsibility to create alignment with our partners.  We also need to provide the opportunity for innovative vendors with great solutions in health care to have a delivery channel that makes sense for all.

For the adoption and sustained use of digital health products and services, robust change management support is a core ingredient.  This support is available to  physician practices anywhere in Ontario and  provided by Practice Advisors with in-depth knowledge of EMRs and other digital health products and services; a network of over 50 Peer Leaders (physicians, nurse practitioners and clinic managers) mentor and educate physicians and their staff on how to make improvements to their EMR use; and the EMR Practice Enhancement Program that provides intensive coaching for physician practices to standardize data, improve the quality and integrity of data, improve preventive care, improve internal workflow processes to enhance the patient experience and much more.  We agreed that digital health is often NOT about the availability of technology, but about creating capacity and support for the clinicians who are end users.

The delegation and OntarioMD had a lot of shared themes to discuss – from population health priorities, the impact of privacy and security, access to data, quality improvement, and patient engagement and how innovation and new technology will continue to present great opportunities and challenges alike. Norway has tackled many of these themes and has also developed methodologies and best practices that have been effective in its digital health eco-system. With increased globalization, we increasingly recognize that forums, such as the one we were privileged to participate in, will continue to advance our paradigms and challenge our thinking about the future of digital health.