Ready or not

Issue: BCMJ, vol. 51, No. 5, June 2009, Page 190 Letters

The topic on your April cov­er should really have read “Assessing EMR’s readiness for BC physicians.” I’m definitely not an expert, but I have keenly followed the EMR issue for several years because I firmly believe that technology can save general practitioners by rescuing us from the endless data drudgery in which we are increasingly mired. Unfortunately, it looks like we are only partway there.

It’s 2009. I just don’t understand why I can’t have a patient in front of me talking about her depression while my computer, which contains the patient data showing she is diabetic, automatically determines that she is due for a HbA1c, lipid profile, and AC ratio; securely transmits an electronic requisition in my name to the appropriate lab facility; and prints a self-explanatory reminder explaining the nature of the lab work, the fasting required, and the location of the lab facility, which I can then hand to the patient as she leaves. Although systems have improved over the years, our best EMR systems fall well short of this level of functionality. They are roughly the computing equivalent to the wringer washing machine: definitely better than manual, but half the drudgery is still left to the operator. And I’m a tad worried that if we all settle for wringer washers, the fully automatic version could be a long time coming.

I practise in the Interior Health Authority, which means that in my community the Meditech lab system has a monopoly on our lab information. Until about 2 years ago, Medi­tech was unable to interface with any major EMR system in North America (except its own notoriously weak product). For our multidoctor clinic, which for several years has wanted to implement an EMR, this has been the showstopper. Recently, one system (Practice Solutions) has achieved an interface that I understand is now operating in a live environment but—guess what—it has been deemed PITO-ineligible! IHA has been working quite hard for around 2 years on an interface with a PITO-approved system, but this has apparently proved a daunting task and to my knowledge is only just now getting to the point of real-life implementation. Isn’t this all something like hiring a hospital ad­ministrator without realizing he only speaks, say, Polish, then implemen­ting an employee Polish-language program, firing the administrator’s Polish-speaking secretary, and then, when doctors fail to communicate, lamenting their lack of readiness?

How will maximal functionality be achieved? Improved vendor software for sure, but an integrated effort is also needed. The IT departments need to be convinced that their entire mission in life is to serve the needs of the patients and frontline health care providers, not, as it too often seems, the other way around; the bureaucrats need to listen to the frontline providers and be ready, willing, and able to remedy the progress-killing situations in the system; and doctors will need to come to the table with understanding, ideas, and useful feedback.

The saying “build a better mousetrap and the world will beat a path to your door” is as true as ever. BC doctors are not exactly beating a path to the EMR door, and I doubt it’s from lack of readiness, whatever that really is. Instead of putting all our effort into frantically paving this untrod pathway with elaborate funding incentives and support programs, shouldn’t we all be working harder on the mousetrap?

—Ivor McMahen, MD
Williams Lake

Ivor McMahen, MD,. Ready or not. BCMJ, Vol. 51, No. 5, June, 2009, Page(s) 190 - 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