Care access up in Canada but electronic medical-record use lags behind

Family doctors in Canada are providing increased access to care compared with most of their counterparts in 10 other countries but still lag behind when it comes to using electronic medical records, findings of a survey show.

The Commonwealth Fund Survey also found few doctors can share patients' lab and diagnostic test results because health systems are not fully connected.

It involved over 13,000 doctors, 2,500 of them from Canada, and was the basis of a report released Thursday by the Canadian Institute for Health Information.

Physicians from Germany, France, Australia, the United Kingdom, the Netherlands, New Zealand, the United States, Switzerland, Norway and Sweden also participated in the 2019 survey, which showed doctors in all the countries saw an average of 99 patients a week.

Doctors in Germany saw 200 patients a week, the highest number, with physicians in France seeing 120.

Doctors in Australia saw 110 and Canadian physicians tied in fourth place with the U.K. and Netherlands with 100 patients seen.

Swedish doctors saw the fewest number, at 40 patients a week, the data show.

In Canada, there was variability among jurisdictions, with doctors in Newfoundland and Labrador seeing 145 patients a week, the highest in the country, while those in Quebec and the territories saw 70 patients, the lowest number.

Access to care has improved for Canadian patients since 2015, with an increasing number of doctors working in group practice so patients can also be seen by their colleagues.

They have also provided more weeknight and weekend appointments versus their counterparts in the other countries, says the survey, which has been done every four years and for the first time since debuting 20 years ago has started including the territories.

It found 62 per cent of Canadian physicians think that better integration of primary care with hospitals, mental health services and community-based social services is the top priority in improving quality of care and patient access.

Use of electronic medical records has increased in Canada, with 86 per cent of doctors using them, up from 73 per cent four years earlier, the survey says, but the current number is still below the average of 93 per cent among all the countries.

Across Canada, 96 per cent of primary care physicians in the territories used electronic medical records, with Alberta in second place at 92 per cent and Prince Edward Island doctors last, with only 26 per cent of them using the technology.

Less than half of Canadian family doctors routinely used electronic medical records to support their quality-of-care decisions, with 26 per cent of them sending patients reminder notices for regular preventive or follow-up care, such as getting the flu vaccine.

The average among all the countries was 51 per cent, the data show. Tracy Johnson, director of health systems analysis and emerging issues for the Canadian Institute for Health Information, said the increasing use of electronic medical records has helped with co-ordination of care and should increase access to care. "When it's fully operational people can access appointments online, they can ask questions online so you might not have to come in for an appointment."

However, Johnson said some jurisdictions in Canada may not have billing codes allowing doctors to get paid when they communicate with patients via email.

The survey says 23 per cent of Canadian doctors offer patients the option to ask medical questions by email or a secure website versus the average of 65 per cent in the other countries.

It says 10 per cent of patients in Canada can request prescription renewals online compared with an average of 52 per cent elsewhere.

Canada Health Infoway, a federally funded not-for-profit organization, started funding provincial programs in the late 2000s to provide doctors with financial incentives and peer support to bring electronic medical records into their practices. Simon Hagens, senior director for performance analytics with Infoway, said increasing connection to centralized electronic health records allows family doctors to access data they need.

"Absolutely there is room for improvement in terms of connecting those systems and sharing information back and forth between local and provincial systems," he said.

Hagen said an initiative called Access 2022 aims to provide patients with their own health information and online services, such as booking doctors' appointments and connecting with their primary care providers by email.