by Dr. Michelle Greiver

I would like to thank OntarioMD and the OMA Section of General and Family Practice for allowing me to provide some periodic reflections during this Annus Horribilis. I am a community-based family physician and have been doing Practical Research in Family Medicine for the past 20 years. 

This started with a patient on a Friday afternoon 20 years ago.  He had chest pain and I was not sure what investigations were best for him. I found some guidelines, but they were long, specialist driven and hard to apply in my small practice. There had to be a better way.

I had recently bought a PDA (Personal Digital Assistant), a small handheld computer which was a precursor to smart phones during the Jurassic Period.  I thought I would program the guideline for the PDA so it would help me with what to do. The next question was:  would this help anyone else? I got some help from Academics and we ran a randomized controlled trial; I asked friends and colleagues to participate. Half the family physicians were randomly chosen to receive a PDA with my program and the other half continued with usual care. Physicians in the second group were not too happy with me because they did not get a PDA. The result:  https://www.cfp.ca/content/51/3/382 . 

I was now curious about many other things in my practice, which has led to no end of trouble.

I started using an EMR in my practice in 2006 and documented the journey at https://drgreiver.blogspot.com. I thought EMRs would improve the care I provided to my patients — I was very sure care would be better and was determined to use scientific methods to prove this to everyone.

I compared preventive services for a group of colleagues implementing EMRs and a group continuing to use paper records. I looked at influenza vaccinations, Pap tests, colorectal cancer screening tests and mammograms. Much to my dismay, there was absolutely no difference. To my even greater dismay, the study won the 2012 Canadian Family Physician Best Original Research Article award. I also ran focus groups to find out what my colleagues thought of their EMRs; there were many complaints about unexpected costs, software problems, computer crashes and lack of ongoing training to enable more advanced use.

Have things changed? Efforts at OntarioMD and by many physicians to improve the way we use EMRs are likely making a difference. Perhaps I should re-do my study and revisit my conclusions! 

The curiosity has led me to think about more uses of EMR data, and this resulted in participation and leadership in our Practice Based Networks (see for example, UTOPIAN), more Quality Improvement activities and many research projects. My life became enormously enriched by working with many smart, innovative, and interesting people; my friend Dr. Darren Larsen tells me that I do a great job finding potential collaborative partnerships.    

Here is another example of a project that came out of conversations with colleagues. Have you ever been curious about the number of medications we prescribe to our seniors? About one in four Seniors across Canada are on 10 or more medication classes! Using UTOPIAN EMR data, we found that each family physician looks after, on average, 24 older patients that were prescribed 10 or more different medications in the past year. 

Can we do something about this? My colleagues across several Learning Networks have partnered with family physicians and their practices across Canada. We think that audit and feedback with EMR data, practice coaches and Learning Collaboratives to share innovations with each other can help family physicians as they deprescribe drugs like benzodiazepines or antipsychotics for our elders taking many other meds. This could make a difference to seniors’ health and lives:  fewer falls, less risk of admission to Long-Term Care. We are testing this in a randomized controlled trial which received $2.6 Million in funding; please see https://www.spiderdeprescribing.com/ . 

Now I need your help.

We can only understand the impact of COVID-19 on our practices and our patients through collecting and analyzing health data — the stories of patients seen in our practices need to be heard.  The pandemic has exposed many data gaps in Ontario. Family doctors are vitally important to ensure our data are included, as our information reflects our settings, patients and communities. Collectively, family medicine’s voice can be heard through providing safe and secure access to real-world data. This is possible with your help.

By agreeing to supply data through our practice networks, you contribute to a secure provincial base of evidence that will strengthen family medicine’s capacity to learn about this pandemic and prepare for the next one. This includes effects on preventive services, chronic disease management and long-term outcomes for our patients. For more than 10 years, we have been safely and securely collecting EMR data from practices of consenting family physicians, with full privacy protection, to study and promote the vital work done in family practices. The data can be used to help make the case for the importance of investing in family medicine.

The time and effort it takes to participate is minimal:  all you have to do is fill out a consent form and a brief survey; our staff will co-ordinate data extraction at your practice, with all safeguards in place.

Please help us to build practical evidence in family medicine, by supporting our collective Culture of Curiosity and by contributing data to our Practice Learning Networks. The time and effort it takes to safely and securely contribute is minimal; please see https://www.dfcm.utoronto.ca/contribute-emr-data.

Michelle Greiver MD, MSc, CCFP, FCFP. Gordon F. Cheesbrough Chair in Family and Community Medicine, North York General Hospital. Director | University of Toronto Practice-Based Research Network (UTOPIAN). Associate Professor, Department of Family and Community Medicine, University of Toronto. Lead – Digital Health for Research and Care, Diabetes Action Canada. Adjunct Scientist, ICES