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eChart Manitoba offers quick access to health information

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The patient walked into the Emergency Department at Seven Oaks Hospital one day last year complaining of chest pains.

After a quick assessment, Dr. Ricardo Lobato de Faria, the physician on duty that day and the Chief Medical Officer at Seven Oaks, surmised that the man was suffering from an irregular heartbeat, also known as arrhythmia.

"There were two possible reasons for this," says Lobato de Faria, recalling the day's events. "Either he didn't have enough of his anti-arrhythmia medication in his system or he had too much."

The problem, of course, is that Lobato de Faria could not know for sure.

In situations like these, the best move is to assume the patient's medication level is too high. The standard emergency treatment in this case would be to use electric shock to reset the heart rhythm.

Fortunately, Lobato de Faria did not have to make these assumptions in diagnosing and treating his patient. That's because Seven Oaks is part of eChart - a new electronic health record system that allows health-care providers to access certain records with the click of a mouse.

In this case, Lobato de Faria knew the patient had recently visited his family doctor and so he tapped into the patient's eChart record.

A review of the information revealed that the patient's medication level was too low. As a result, the patient's arrhythmia was treatable simply by increasing his dosage of medication, without the need for an electric shock. And the benefit of eChart in this case didn't end there. Even if electric shock had been used to reset the patient's heart, chances are it would have fallen back into arrhythmia again because the underlying problem was the medication level.

Lobato de Faria says the case of the heart patient helps underscore the importance of the new electronic record system. "Using eChart altered the path of care," he says.

Thanks to eChart, physicians like Lobato de Faria can quickly get an answer to a question that in the past would have required telephoning a lab, pulling a file from a cabinet, or waiting for busy staff members to send and receive faxes. Simply put, by providing instant access to information on one secure electronic database, eChart is helping to improve patient care, reduce wait time for patients, and cut expenses and downtime for the health-care system.

Lobato de Faria says the system, which was launched at Seven Oaks in late 2010 and is being implemented at various locations throughout Manitoba, is a major improvement over the old paper record system. He cites a case in which a patient had a bladder infection and had a urine sample sent away for testing. When the sample comes back three days later, the physician needs to review the patient's file and see if he or she was prescribed the right antibiotic. Using eChart, that information is at the physician's fingertips.

"I can check right away without pulling any files. In the past, you'd have to get somebody to pull the chart, and that takes time. By decreasing the amount of time the person waits, you make it safer for the patient," he says.

Another problem with paper charts will be familiar to anybody who has ever attempted to read a prescription: interpreting the physician's handwriting. Still another benefit in the Emergency Department comes when immediate access to immunization records allows a patient to avoid an unnecessary tetanus shot after coming in with a wound to be treated.

Dr. Tunji Fatoye, a physician at the Kildonan Medical Centre, which acted as one of the pilot sites for eChart, has seen other instances where more rapid access to information has had potentially significant impacts on health.

He recalls an occasion last fall when a newborn was taken to the Children's Hospital on a Thursday with a bladder infection. A urine sample was taken and sent to be cultured. Because it takes a few days for the culture to grow so that the correct antibiotic can be prescribed, Fatoye checked eChart throughout the weekend to see if the result was ready. As soon as the lab had a result, on the Monday morning, he was able to prescribe the right antibiotic.

Before eChart, when the transfer of information was a matter of phone calls and faxes, it would have taken another full day to get that information. "The child was able to be treated one day earlier, which, at two or two-and-a half weeks, is a huge difference," he says.

Fatoye compares access to information before and after eChart. "A patient comes in and says, 'I was at the Victoria General Hospital last night and they did blood work.' I ask our staff to call the Victoria and then we wait. They fax a Release of Information form, and I sign it and send it back. We wait for the information. In the meantime, the patient goes out to the waiting room."

Now, when that same patient mentions the blood work at the Victoria, Fatoye can simply look it up on his computer and "what used to take 30 minutes or sometimes an hour is right there."

Sometimes, he says, the search for lab results might be so time-consuming that patients would simply be sent for another round of tests, leading to unnecessary testing that costs the entire health-system money.

The other common situation comes when a patient requires a refilled prescription. "But they're on 10 medications. I ask 'which one?' They say, 'The little blue one.'" With eChart, Fatoye can see all the medications, and can tell which ones were prescribed by which doctor.

Lobato de Faria acknowledges that there are two main challenges in using eChart now.

One is that eChart isn't yet integrated with the computer systems used by the staff in the Emergency Department. But that step will come and will make the new system more convenient for use in the department.

The other is that there are still gaps in the information available through eChart.

"There's a lot more that will come through as eChart and other systems are more integrated," he predicts. "Because not every lab is on board yet, the information is going to have gaps. As more and more labs get on board, there will be fewer gaps."

Still, eChart is already proving its value in the Emergency Department, so much so that his colleagues are also making use of it. "I've got two more colleagues doing this now," he says.

Currently, eChart is available at 37 hospital emergency departments, doctors' offices, clinics and access centres across Manitoba. More access points will be added as implementation continues, and other kinds of information are being added to the database as well.

"It's about providing the right information at the right place at the right time," says Liz Loewen, Director of Coordination of Care for Manitoba eHealth. "Anything you can do to make all these systems function more smoothly for the clinician is good news."

In the most recent upgrade to the system last fall, physicians' patient encounter information at St. Boniface Hospital was added as well. This means that each time a patient sees a doctor at St. Boniface, the visit and the reason for it is recorded. Other hospitals will be added as they upgrade computer systems.

Rick Guerard, Project Director for eChart with Manitoba eHealth, says the program is designed to ensure better care by improved information sharing. "The goal is that anybody who needs the information to perform their work should have access," says Guerard.

At the same time, the system has a number of tools built-in to protect privacy.

The database and desktop are designed to present health information in a clear and easily used format. Authorized users can search by a person's Personal Health Information Number, hospital record number, or name and date of birth. They are then presented with a screen that identifies the individual and has a series of tabs along the top: encounters, condition, medications, laboratory, immunization, imaging reports and clinical documents.

In addition to providing the information on each tab, the system has a design feature that allows users to see trends in the patient's lab results. Under the laboratory tab, a series of tests can be viewed over time as a graph.

As more information is added to eChart and more locations have access, Manitobans will find that their health information is available no matter where they go in the province. "We've got a lot of patients who need to come into Winnipeg for tertiary care service and now their information can follow them home," says Loewen.

The longer term national goal is for each province's equivalent of eChart to be connected to each other. Over time, Canadians may find that their health information is available to their healthcare providers when needed as they move or travel within Canada. "It's sometimes easy to forget just how game-changing this system is," says Loewen.

Bob Armstrong is a Winnipeg writer.

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