Doctors want NL to ban a mandatory, province-wide electronic health information system

Doctors in Newfoundland and Labrador say the rapid implementation of a province-wide electronic health information system risks harming patients and forcing some physicians to retire or leave the province.

The province’s health authority says its electronic health information system, CoreCare, based on the Epic software platform used in much of Canada and the United States, is scheduled to launch on April 25.

NL Health Services says CoreCare promises to modernize health care by replacing legacy systems like Meditech, providing a single, unified digital record to improve patient care, efficiency and data sharing across the province.

Nobody wants to work with someone who says you have to sign it in order to do it. I mean, this is not partnership, this is dictatorship.– Dr. Sarah Tulk

Hundreds of physicians in the province are concerned about how it will be launched. More than 250 of them have signed a petition calling on the province’s health authority to slow down the implementation of the CoreCare system so it can be implemented gradually, in phases.

St. John’s dermatologist Dr. Bolu Ogunyemi hopes a province-wide electronic medical system will eventually improve health care in Newfoundland and Labrador, but he signed the petition and a letter to the province’s health authority because he believes the way CoreCare is being implemented is flawed.

“When you have a lot going on at once in many different settings, it creates potential risks for patients,” he said.

“Even if a blood test is missed, or any other test or investigation or imaging that could have real consequences for patients, whether it’s missed or whether it’s delayed – that’s unacceptable. Many community-based doctors are accustomed to using either electronic medical records or even paper charts and now they’re being forced to use this brand new system at the launch date, which increases the risk of some of these things happening.”

Community-based therapists call for change

Community physicians, who operate their own businesses and bill MCP on a fee-for-service basis, have concerns about the 35-page agreement they are required to sign for their patients to access the new system.

They want the CoreCare Link, the part of the system that provides community physicians access to CoreCare, to be delayed and some of them believe it should not be mandatory.

“Being mandatory is just… it doesn’t really sell Newfoundland and Labrador as a province where physicians would want to live and work. Nobody wants to work with a bullying person who says you have to sign this to do this (get access to CoreCare). I mean, it’s not a partnership, it’s a dictatorship,” Dr. Sarah Tulk, a family physician in St. John’s, told CBC News.

“It’s not going to make anyone want to come and work here, especially when we already have some people against us when it comes to our medical system.”

Both Ogunyemi and Tulk said they have spoken to physicians who have said they would rather retire early than accept the CoreCare implementation in its current state.

Both said it could seriously hinder the province’s efforts to recruit and retain doctors at a time when the province is already facing a physician shortage. Access to a family doctor in NL already lags the national average, Ogunyemi said.

A report by the Canadian Medical Association found that an estimated 29.1 per cent in the province do not have it, compared to about 17 per cent nationally.

“We’re really staying above water here,” he said.

Physicians must sign a portion of the agreement to gain access to CoreCare, which is particularly troubling for some people. They say the settlement would give them liability, making them financially responsible for health information system violations. They fear that dramatic cyber attacks could cost them as of October 2021.

“If they’re not flexible and able to make changes, I think the practice will have to stop…that’s going to have to happen because as things stand, I can’t sign that contract,” Tulk said.

“I don’t know if I would have to close my practice if I couldn’t do that. I mean, there are some, I might be able to find some creative solutions for some of my patients. Like, I would definitely do my best for them.”

Tulk says this can be a real problem for physicians who still use paper medical records and can have an impact on their patients.

“There are some family doctors who are still working in paper-based practices who are providing excellent care to a massive patient roster who have said they can’t do that. So if NLHS really, really wants to reinforce that this is going to be mandatory, they are essentially pushing those physicians out of practice and that’s a patient load that the system will not be able to absorb,” she said.

A letter signed by Dr. Ogunyemi and six other community-based physicians was sent to the provincial government and the health authority. It was titled “Urgent: A call for the safe and fair implementation of CoreCare and CoreCare Link.”

“NLHS acknowledges that the launch of CoreCare will reduce access for patients during the transition period,” the letter said. “Proceeding with the concurrent rollout of CoreCare Link risks exacerbating these disruptions to both NLHS-based and community-based care at the same time. This creates a real and immediate risk of decreased access to care for patients across the province.”

NL Health Services says it’s listening

CBC News asked the health authority for an interview with its CEO Ron Johnson, but received an emailed statement instead.

It reads, “NL Health Services appreciates physicians taking the time to share their perspectives and we are continuing to work closely with the Newfoundland and Labrador Medical Association (NLMA) and physicians to understand and respond to their feedback with a shared focus on improving the health care experience for patients.”

“NL Health Services is listening, and will ensure that the voices of physicians will help inform the successful rollout of CoreCare.”

Nevertheless, the health authority made no changes.

“CoreCare is on track for implementation by April 25,” the statement said.