Strengths, weaknesses in
physician use of IT
OTTAWA – Seventy (70%) of Canada’s
physicians have high-speed Internet connections in their office, and 68%
of the doctors say they’ve got intermediate or advanced skills with
computers, according to the National Physician Survey, which just
released the results of its 2007 polling.
That’s a surprisingly high level of skill and readiness – and it’s at
odds with traditional views of Canada’s physicians. In the past, doctors
have often been perceived as Luddites who turned up their noses at
The National Physician Survey is a joint project of the College of
Family Physicians of Canada, the Canadian Medical Association, and the
Royal College of Physicians and Surgeons of Canada. The partners are
surveying GPs, family docs, specialists, medical students and residents
across Canada every three years to examine what they’re doing – or
planning to do – in their practices.
The 2007 National Physician Survey contacted 60,811 Physicians. Of
these, 19,239 replied to the survey, for an overall study response rate
of 31.6%. Fifty-eight percent (58%) of eligible respondents were
contacted initially by email, and the remaining 42% by regular mail.
Questions pertaining to the use of computers, electronic health records
and other advanced solutions formed part of the survey.
Interestingly, 50% of the doctors say they use e-mail to communicate
with colleagues for clinical purposes, and 13% are using e-mail to
communicate with patients for clinical reasons. Only 10% of doctors say
they don’t use e-mail.
It appears that physicians are now readily using e-mail as a technology
that obtains answers to questions much more quickly than their
traditional tools – telephone and fax.
No discussion was provided about whether physicians are using any forms
of security or encryption when e-mailing clinical information or
On the topic of patient records, most doctors are still using paper
charts. According to the survey, 58% of physicians maintain paper
records for their patients, while 26% have a combination of paper and
electronic records. Only 9.8% use electronic medical records instead of
Nicely, the survey makes a distinction between “having” an EMR and and
actually “using” them.
In the case of EMRs, 25.7% of doctors say they are using electronic
records to enter and retrieve clinical patient notes. (Specialists are
more apt to use computerized solutions. While 23.6% of family docs/GPs
said they use EMRs, 28% of specialists said they use them.)
Age also appears to be a factor in the use of EMRs – according to the
survey, the older the doctor, the less likely is the usage of electronic
records. For example, nearly 32% of physicians 35 or under use
electronic records; 26% of doctors who are 45-54 make use of them; but
only 18% of doctors 65 or older say they use EMRs.
While 30% of doctors use electronic connections to external labs and/or
diagnostic imaging clinics, only 3.9% use a connection to an external
pharmacy. Despite the potential benefits of e-prescribing for patient
safety, this application is still in its infancy in Canada.
Another weak spot: while 19% of physician make use of electronic
interfaces to other external systems for accessing or sharing patient
information (such as hospital portals), a mere 2.3% have interfaces to
chronic care registries.
Of this 2.3% who have them, 1.7% say they use them.
The low rate of connections to chronic care registries would certainly
be worth further research and discussion.
Although patients with serious, chronic problems require close attention
by caregivers, it is probably difficult to obtain fast, electronic
access to their records.
Complicating matters is the fact that chronic-care patients are likely
to have records in a variety of locations – physician practices,
hospitals, long-term care centres, and specialist clinics. In some of
these facilities, the records may not yet be computerized!
Nevertheless, some progress is being made. As a better way of caring for
patients with chronic diseases, some jurisdictions are now building
targeted ‘patient population’ registries. For example, the
Kitchener-Waterloo area of Ontario has developed a cardiac care database
for the region’s heart patients. (See Canadian Healthcare Technology’s
April 2008 issue for a profile of this innovative, cardiac-care
On another front, use of wireless technologies by doctors is
surprisingly low, according to the report. For example, only 2.5% of
physicians use wireless systems to enter and retrieve clinical patient
Only 4.6% of physicians use wireless warning systems for adverse
prescribing and/or drug interactions; 4.5% use wireless applications for
No reasons are given for the results; perhaps doctors are concerned
about the security aspects of wireless systems.
IT-related issues constitute only one part of the extensive NPS survey.
Other principal findings of the report included the following:
Patient access to specialists
• 71% of family physicians ranked access to psychiatrists in Ontario as
fair to poor, compared with 45% of family physicians in Saskatchewan.
• 61% of family physicians in Quebec ranked access to orthopedic
surgeons as fair to poor, compared with 26% in Prince Edward Island.
• 72% of family physicians in Prince Edward Island ranked access to
ophthalmologists as fair to poor, compared with 25% in Saskatchewan.
• 57% of physicians in British Columbia and Saskatchewan ranked access
to diagnostic services (e.g. CTs and MRIs) as fair to poor, compared
with 34% in New Brunswick.
Several significant trends in physician practice patterns are
highlighted in the NPS results:
• Based on the 6% who plan to retire, we can expect upwards of 4,000
physicians leaving clinical practice over the next two years. Intentions
to retire are consistent province to province.
• Gaps are being increasingly filled by a female physician cohort.
Studies have shown this to have positive impacts on doctor-patient
relationships, service organization, and access to services, while
having significant implications for future resource planning. Currently,
33% of all family physicians under the age of 35 are women in Prince
Edward Island, and this percentage rises to 72% in Quebec.
• In 2004, 26% of physicians planned to reduce their hours. The 2007 NPS
confirmed that in fact 27% of physicians had reduced their hours over
the last two years. Now, 35% of physicians plan to reduce their weekly
work hours over the next two years – from 28% of family physicians in
Manitoba to 37% of family physicians in Quebec and the Territories; and
from 30% of other specialists in Prince Edward Island and Nova Scotia to
40% in Quebec.
“The NPS partner organizations challenge all levels of government and
health authorities across the country to develop a pan-Canadian strategy
that will effectively address the urgent issues identified in the NPS
results that further threaten Canada’s health system,” said Dr. Ruth
Wilson, President, The College of Family Physicians of Canada. “We need
to work together to enhance the education, training, recruitment and
retention of physicians to ensure a sustainable workforce that can meet
the healthcare needs of Canadians in all provinces and territories.”
Complete survey data can be found at the National Physician Survey web
site, located at: