Re: Innovation is everywhere. Why isn’t it here?

Issue: BCMJ, vol. 60, No. 10, December 2018, Pages 480,482 Letters

It was interesting to read Dr Cadesky’s comments about the failure of innovation in health care [BCMJ 2018;60:389]. One of the remarkable and potentially game-changing functions is physicians’ use of computers to keep records. This is something I have been involved with for over 30 years and observed on many committees and projects in British Columbia, Canada, and internationally. It has been frustrating to see ideas that were put forward 20 or 30 years ago still not come to fruition. British Columbia has been a world leader in a number of areas related to the use of computers, including the innovation of high-speed Internet and the development of PharmaNet.

The current crop of EMR products cause a lot of frustrations among users, and it has been reported that EMR difficulties contribute to physician burnout. There is, thankfully, finally an awareness of the importance of being able to exchange data between different providers and organizations. Over the years work has been done in British Columbia to define the requirements for facilitating the exchange of clinical data. There is continued frustration that movement toward incorporating these requirements into EMRs has been very slow. EMR vendors do not seem to be willing to accept that their products are in need of a lot of remediation. Organizations that generate data like hospitals and laboratories are also slow to replace aging systems that are not capable of generating reports in a manner that could be easily consumed by systems in our offices. Finally, physician organizations have not been willing to support physicians who are willing to work on defining the EMR requirements to the level of detail that is needed to achieve interoperability. Various projects in BC and elsewhere in Canada, including Infoway, have repeatedly defined important elements as being “out of scope,” and there was an unwillingness to “get into the weeds.” As a result we have to deal with EMR vendors that have a rudimentary understanding of clinical workflows, what data we need, and how it should be presented. It would be nice if there was support for a small group of physicians to work on the details that would make things operate at the high-performance level that we are all hoping for. This group could be either at the provincial or national level.
—Raymond Simkus, MD

This letter was submitted in response to “Innovation is everywhere. Why isn’t it here?”

Raymond Simkus, MD. Re: Innovation is everywhere. Why isn’t it here?. BCMJ, Vol. 60, No. 10, December, 2018, Page(s) 480,482 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply