Computers are gaining traction in doctors' offices across the country as physicians increasingly see benefits from technologies such as electronic medical records, speech-recognition software, digital communication and drug interaction databases.

While computers have been common on the front-office side for clerical tasks such as billing and scheduling, these same systems are now finding their way into examining rooms and other treatment areas.

Dr. Michelle Greiver is a case in point. The Toronto general practitioner's office staff have had computers since 1993 when the Ontario government began to encourage electronic billing. Yet she only recently decided to make technology integral to her practice, implementing an electronic medical record system (EMR) earlier this year.

The EMR software will effectively bring all of Greiver's paper-based files, including charts, test results and notes from patient visits, into a digital filing cabinet.

Photo courtesy of Dr. Michelle Greiver
Dr. Michelle Greiver of Toronto has made technology integral to her practice by using an EMR system to access her files.

EMR even offers the capability to file prescriptions electronically with pharmacies, order lab work, share pertinent information with specialists and analyse patient data in new, efficient ways.

Greiver says the implementation of an EMR system and the overall move to an electronic environment significantly advance the level of care she can provide.

"There are tons of things I can't do on paper. To see whether all my diabetics have good blood sugars I'd have to pull tons of charts, look at each level and then record the data. I'm so busy with my practice, I simply haven't had time to do this kind of an audit. With EMR, I just push a few buttons and I can track an entire area to see how my practice is doing," she says.

The 2003 SARS outbreak in Toronto raised the stakes for Greiver, who found herself quarantined and more isolated from information sources than she cared to be.

Last year, when the Ontario government announced subsidies for physicians, she jumped at the opportunity. "All of a sudden it was financially feasible and I wasn't the only one wanting to do it."

Bill Pascal, chief technology officer with the Canadian Medical Association, estimates 95 per cent of the country's 62,000 licensed physicians have some kind of office computer system. While these are mostly used for billing and scheduling, he says roughly 15 to 20 per cent of doctors have EMR systems.

Although this number is rising, Pascal cautions that statistics are difficult to quantify because doctors often work from multiple locations, including clinics and hospitals, and do not always specify where their EMR is based. The market is further complicated by the fact that the technology is in its relative infancy.

"You probably have 40 companies that say they have an EMR product, but not all of these are as robust as you would think. Because it's such a relatively young marketplace, the smaller EMR vendors often can't afford to offer a full suite of service and support. There are probably 10 to 12 that are fairly mature," he says.

Pascal expresses optimism for the future of EMR. "I think there's a huge spend that's going to occur in that part of the marketplace over the next five years, in the order of $1.5-$2 billion in Canada. Then there's the ongoing maintenance. The figures I've seen suggest it costs about $8,000 to $10,000 a year per doctor to keep a system up and running."

While EMR is just coming into its own, pieces of this over-arching technology have made headway over the past few years. Speech-recognition software is one example.

Specialists have long used tape recorders or dictation equipment to dictate the results of patient encounters, with staff or outside services transcribing the information to paper.

However, improvements in speech-recognition technology have enabled physicians to dictate directly to their computers, creating audio files that can be converted into text, all without having to speak in slow, unnatural ways - something that used to be endemic to speech-recognition software. The advances mean physicians can dictate their notes directly to a computer, with automatic transcription to a patient's paper-based or EMR file.

Charles Marriott of Talk 2 Me Technology, a Canadian distributor specializing in dictation and speech recognition technology, says Dragon NaturallySpeaking, by far the dominant player in North America, offers a medical version with specialist vocabularies for practices as varied as gynecology, oncology and mental health.

Doctors can dictate from multiple locations that are connected to a server-based network and they can create tailor-made speech commands to input lengthy or routine pieces of text, including standard letters.

"Speech recognition is generally a cheaper alternative because the doctors can do it themselves," Marriott says. "It eliminates the transcription costs, which can be significant."

Physicians also are using computers to track medications they prescribe. In response to concerns about life-threatening errors and side effects involving drugs, technology providers have developed software that can reference and cross-reference prescriptions.

Epocrates, Lexi-Comp and Micromedex - all U.S.-based companies - are the three largest providers of web-based databases, which can be accessed using ordinary computers but also handheld devices such as Palms.

Smaller providers include Montreal-based MCS Health, which offers MCS Physician Drug Solution, a web-based application designed specifically for the BlackBerry. Physicians typically click on an icon, type the name of a drug and look up interactions, contra-indications, side effects and dosing.

"MCS Physician Drug Solution tells you if there is an interaction and the degree of severity and it allows you to access the product monograph," says Dr. Joseph Yermus, a Montreal family doctor who is president and CEO of MCS Health.

The data, largely gleaned from First DataBank, a U.S.-based supplier that provides Canadian content, is updated every month or so, as medications are released and new information comes to light. MCS Physician Drug Solution lists roughly 37,000 pharmaceutical and "natural" health-care products, including prescription and over-the-counter drugs.

"We're living in an era with an older population and people are being treated by multiple drugs," Yermus says. "Unless doctors are totally conversant with these drugs, they're really at a loss to know if there are any interactions."

Dr. Mark Cameron, a Regina family doctor, subscribes to Lexi-Comp but also uses an EMR package, supplied by Calgary-based CLINICARE, that includes a prescription-writing and drug-lookup feature. While Cameron uses an office computer much of the time, CLINICARE EMR has a module that lets him download some patient-related information to a Palm he carries on his rounds.

Cameron has even connected with a pharmacy information program (PIP) set up by the Saskatchewan government. Modelled on a similar program, Alberta Wellnet, PIP tracks patient prescriptions across multiple physicians and drugstores.

"If my chart says a patient is on five or six medications and the pharmacy information program says they've only had two medications filled, there's a disconnect. They're obviously not taking medications as I thought they were taking them," he says.

While Cameron praises existing technologies, he calls for further improvements.

"Hospitals still fax ultrasound results and discharge papers. We'd like these to be sent electronically, either by e-mail or on a floppy disc," Cameron says. "We can scan the documents and put them in the EMR, but the problem with scanning is that you can't search for images or for any words they happen to contain. So, you couldn't look up your last 10 chest X-ray results."

What's needed, Cameron says, is software that allows information to be transferred between hospitals and doctors. "I'm optimistic that it will come, but I'm not sure how optimistic I am that it will come soon. Once EMR adoption reaches a certain point there will be a much greater push for this."

(Saul Chernos can be reached at chernos@businessedge.ca)