I'd love to expand on that thought, but I think I must first correct the misinterpretation in the second part of your question. I absolutely do not agree that the holdup in the adoption of IT in the medical profession is the result of physician resistance to the development of EMRs--not at all.
There are two components to this. One is the complexity of the type of information we're dealing with. It is not as simple as what you're thinking of when you think of a dictated record, or the kinds of records that lawyers keep, where really what you're dealing with is note-taking. We deal with information that is much more complex and much more in need of manipulability.
I need, for example, to be able to integrate incoming lab results into my file. I need, if possible, to be able to link those lab results to information about the prescriptions the patient may be taking, and to link prescriptions to both the international prescriptions in our office and external prescriptions that are given to that patient elsewhere. I need to link that information so that drug-to-drug interactions can be managed, and I need to link that to knowledge of the patient's allergies.
The biggest piece of resistance has come from the fact that we do not have systems that are sufficiently integrated, interoperable, and manipulable.
The other issue for physicians is different from those in any other professional industry, if you will, around Canada. My husband is a professional engineer. I know about computerization in the engineering business.
This is an unfunded expense for physicians. As I mentioned earlier, 90% or more of us are self-employed individuals. We do not have external support for any of our infrastructure costs, our capital costs. So if you're asking us to purchase a system, as my office did 10 years ago, where the upfront cost is a quarter of a million dollars spread across seven physicians, with no opportunity to enhance the revenue stream to match that expenditure, that is part of the reason why physicians are asking for special consideration under the CCA--because in fact we need to be able to offset the quite considerable costs. They've come down over time, but they are still quite considerable. Seven doctors could manage a quarter of a million dollars; if you go to two or three doctors, it's not supportable.