PITO responds

I appreciate the opportunity to re­ply to the two letters expressing concern over the process used to select the electronic medical record vendors who will be funded under the new PITO process. Canadian physicians have been slow to adopt EMRs compared with most other industrialised countries. 

Evidence suggests that the lack of funding for EMRs is largely responsible for this slow uptake as the majority of the benefit from adopting an EMR accrues to  the Ministry of Health and our patients. The BCMA and the Ministry of Health were both anxious to accelerate the adoption of EMRs, and as a result the PITO program became part of the 2006 negotiation, which was ultimately accepted by 94% of the membership who voted.

The exclusive use of an appli­cation service provider (ASP) model was, and remains, a requirement for all vendors who wished to bid on becoming PITO approved (this was in the deal accepted by the membership). Part of the reasoning behind this was to ensure that software and security upgrades were consistently and regularly applied. 

Another reason was to allow for the easy flow of clinically relevant information between physicians as needed for the mutual care of our patients. This information will form the Core Data Set. An anony­mized set of data will be available for the ministry to help in health care planning. The Core Data Set must be generated automatically by the EMR so there is no extra work required by the physician.

Another requirement was that up to six vendors would be selected to become PITO approved (the ministry would have liked that number to be significantly lower, but the BCMA wished to provide as much choice as possible for members). The bidding and approval process was very rigorous, and was completely at arm’s length from the PITO Steering Committee and the BCMA. 

In excess of 30 vendors initially responded, and contracts have recently been signed with the six successful vendors. At no time were the PITO Steering Committee members aware of the original bidders, and we are still unaware of who they were, unless those vendors have made that information public themselves.

I understand that there are current EMR users who are entirely happy with their products, and who are disappointed that the EMR they are presently using did not qualify for PITO funding in the first round. I am sure those physicians had excellent reasons for choosing the products they presently use, and made their decisions based on sound clinical and financial reasoning. 

There is no need for anyone to change from their current EMR to a PITO-funded EMR if they are happy with what they have and it works well for them. This would apply to both the various open-source programs available as well as commercial products that did not qualify for funding.

It is incorrect to suggest that data will be stored on a “public Hot­mail-type ASP server with a public ad­dress.” In fact the data will be extremely secure with access available only to correctly identified and authenticated users. Moreover, the data flow not through the regular Internet channels, but along a private network with enhanced security and encryption. 

The College and the privacy commissioner have intense interest in this and are involved in decisions around these issues. The data will be more secure than when it resides in a physician’s office, as evidenced by various office and other break-ins where laptops and servers have been stolen in the past. Through a contract between the physician and the vendor, physicians will remain the custodian of their data, not the government and not the vendor or ASP provider.

PITO funding will be available to all physicians in private practice who wish to avail themselves of the program. The program is entirely voluntary, and, unlike programs in place in some other provinces, is not tied to practice type or method of remuneration.

-Michael Golbey, MD
Co-chair, PITO Steering Committee