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eChart Manitoba allows health-care providers to enhance patient care while saving time and money

Dr. Tunji Fatoye uses the eChart system at his clinic
Dr. Tunji Fatoye uses the eChart system at his clinic.
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eChart Manitoba

BY SUSIE STRACHAN
Winnipeg Health Region
Wave, November / December 2013

Dr. Harold Nyhof calls it the "red zone."

It's the term he uses to describe the time a doctor spends in the examination room with a patient, reviewing his or her medical issues and history. 

"That's when the doctor needs to learn as much as possible about their patient," explains Nyhof.

In the course of a normal day, a doctor may see more than 20 patients. That means the time with each individual patient must be spent efficiently. Anything that slows down the pace of a visit means less time is available for all patients in the waiting room.

"So having to leave the (examination) room and call for test results or medication history slows everything down," Nyhof explains.

In the not-too-distant past, valuable time would be lost because doctors had to chase down test results, medical histories and other records. But that is starting to change in a big way, thanks to eChart Manitoba, an electronic health record system being rolled out across the province by Manitoba eHealth.

Now, filled prescription histories, immunization histories, X-ray reports, and lab results are available in the system and can be reviewed with the patient in the examination room.

And nobody is more appreciative than Nyhof. As the Medical Director for the Primary Care Clinics in the Northern Regional Health Authority, he does clinical work in Thompson, Flin Flon and The Pas. He also oversees the primary care clinics in Lynn Lake, Leaf Rapids, Gillam and Snow Lake.

Nyhof says eChart has been a big help in caring for patients in rural areas of the province, especially those who must travel to Winnipeg to see specialists for care. Doctors in the rural communities and in Winnipeg can see patient information easily and quickly. 

"We can do referral letters online now, including a medical history and current medications," he says. "Instead of having someone hunt up the patient's records from all over the place, I can press a button, collect it all, and send the referral within 30 seconds."

In addition to efficiency, eChart also promotes patient safety, according to Dr. Tunji Fatoye, Unit Director of Winnipeg's Kildonan Medical Centre, one of the first clinics to connect to eChart when it went live in December 2010.

"Before eChart, we had to rely on other people, busy people," says Fatoye. "The hospitals are busy, the labs are busy. It took a long while to see test results. Which meant your day backed up, as you spent more time on each patient, waiting to hear results," he says.

"For example, it used to take 24 to 48 hours to get immunization records. Now I can see them without stepping out of the room I'm seeing the patient in. Or if I wanted to see the records of a patient who recently made a visit to the (emergency department), they often would have to make a second appointment, giving me time to receive the results of tests they had in the hospital and the drugs they were prescribed."

That's where patient safety comes in. Elderly patients, new parents, young people - no one is exempt from memory failure when it comes to remembering what drugs they've been prescribed, or the tests they underwent, while sick in hospital.

"It goes both ways. A patient of mine might land in an emergency department. They can read the tests I've done here, and the medications I've prescribed. Something that looks like an abnormal value might have been taken care of just the week before," says Fatoye, who is also an assistant professor in the Department of Family Medicine at the University of Manitoba's Faculty of Medicine.

The eChart system includes information uploaded from pharmacies, Diagnostic Services Manitoba, Cadham Provincial Laboratory and a number of private laboratories to a secure data system, which can be viewed by authorized health-care providers.

The system was launched in late 2010, with 33 sites participating in the initial rollout. Today, it serves more than 2,000 individuals each month who are supporting health care at over 260 hospitals, emergency departments, primary care clinics, nursing stations and other health-care sites throughout Manitoba. Among the most recent locations are the Winnipeg Health Region's Palliative Care program, Hunter Memorial Hospital in Teulon, the Selkirk Mental Health Centre and the Rehabilitation Centre for Children.

Liz Loewen, Director of Coordination of Care with Manitoba eHealth, says the system was used 20,000 times from April to June of this year. "To me, this substantial growth in a relatively short period of time demonstrates the strong demand for the system from health-care providers," says Loewen, who oversees the eChart system.

One of the recent innovations in the way the service is delivered is a "launch button," which connects eChart seamlessly through the electronic medical record used in some clinics.

"It's much easier to connect this way, rather than having to change over to the eChart system and look up the patient again," she says. "Not all sites have it, but it's definitely in use in clinics that have the electronic medical records, and will soon be available in hospitals that have the electronic patient records."

Dr. Sheldon Permack says eChart eliminates duplication and saves money. In the past, patients might have undergone the same test twice if they made a hospital visit and then were seen later at his private clinic in Winnipeg.

"eChart cuts that duplication. I can see the lab work done at the (emergency department), and that means I don't repeat the test because the patient may not remember what tests they went through," he says.

Permack says the most difficult part of eChart was the initial hook-up to the system. Because he runs a private clinic, his technicians worked for several months with eHealth technicians to get the system running in his office.

"But for family medicine in 2013, technology is such a big part of the practice," he says. "My patients expect this. They love the fact they don't have to wait for their test results to come in the mail, and then make another appointment to see me. It's very satisfying, professionally, to say that my work is being done more efficiently."

As for the future of eChart, the three doctors agree they'd love to see a full history of every patient available online, including the treatment and prescribed medications they received at primary care clinics and hospitals.

Loewen says the information available online will grow over time. "But all new information types need to undergo careful analysis before they are added to ensure the information should be in a system like eChart and can be accurately captured," she says.

Loewen says she is keen on hearing the feedback from both health-care professionals and the public about the eChart system. "People tell us they love the fact they don't have to remember everything before they have to go see their physician," she says, adding that the main focus now for eHealth is to ensure all Manitobans know about the system, and the disclosure directive that is available to them for hiding their personal information, if so desired. "We hear from physicians that their patients tell them they assumed they already had a system like eChart."

Looking around at the bare shelves where hundreds of patient charts were once filed at his Waverley Street clinic, Permack says eChart and the electronic medical record are transforming care. "It's changing the way we do things, and I hope to see more integrated care coming down the line that keeps up with the way technology is changing."

Susie Strachan is a communications advisor with the Winnipeg Health Region.

Wave: November / December 2013

About Wave

Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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