Technology continues to transform the world. With the move from paper to electronic information management, all sectors have experienced transformational change in the way information is collected, used, and communicated. Health care is no exception.
This change has an impact on physicians and the practice of medicine. As the regulatory body for physicians, the College of Physicians and Surgeons of Ontario (CPSO) has an obligation to monitor these changes and respond as necessary to ensure public protection and clear accountability.
The College is supportive of eHealth initiatives that assist physicians in providing safe, quality care to patients, increasing system efficiency, and fostering collaborative care while protecting the privacy of patients and the confidentiality of their personal health information.1
The eHealth landscape is evolving quickly; in the near future, comprehensive imaging, laboratory and drug information about patients will be available to all physicians electronically.2 Eventually, most patient information will be electronically manageable, and an electronic health record (EHR) may serve as the basis for most patient care and communication.
The use of eHealth tools (e.g., electronic medical records (EMRs), electronic health records (EHRs), medical applications etc.) has some inherent advantages over paper-based medicine.3 Improved legibility, quick access to resources, decision support at the point of care, reminders, alerts and care maps for defined sets of patients, data analysis to assess quality and track outcomes and the ability to share patient information across health providers and institutions, all have the potential to improve patient safety and quality of care.4
The College, physicians and others in the health-care system have an obligation to monitor and respond to the changing environment, which will support and demand an unprecedented level of collaboration and information sharing.
This statement outlines the role of the College, physicians and others in the health-care system in an eHealth environment. A statement does not set out new expectations for physicians.5
eHealth – The provision of health-care services supported by modern electronic information management tools, processes and resources.6
eHealth Literacy – The awareness of and ability to use relevant eHealth tools, processes and resources that facilitate best practice and the provision of quality care.
Electronic Medical Record (EMR) – A digital version of the paper charts in a physician’s office. An EMR contains the medical and treatment history of the patients in a practice.
Electronic Health Record (EHR) – A record that includes a patient’s health history and care7 from multiple physicians and/or health-care providers.8 EHRs are designed to extend beyond the practice, health organization or clinician that originally collects and manages the information.9
Personal Health Record (PHR) – A health record where health information related to the care of a patient is securely and privately shared with the patient and components of the record are
maintained by the patient.10
Information Management (IM) – The collection, management and analysis of information (from one or more sources) and the appropriate communication/distribution of that information.
The College’s Role
As the regulatory body for physicians in Ontario, the College’s role is to:
Promote physician eHealth literacy, and encourage the effective and appropriate use of technology by physicians to provide safe, quality care to their patients, while protecting privacy and confidentiality;11
Monitor the environment (internal12 and external), and work collaboratively with stakeholders to ensure that proposed technology both complies with professional and clinical standards and allows
the College to regulate the profession effectively;
Share information with our health-care partners, where permitted, about eHealth issues/benefits and/or physician eHealth adoption; and
Incorporate eHealth expectations into existing policies and/or develop new policies as the need arises.13
In fulfilling this role, the College will do so in a way that is consistent with the Regulated Health Professions Act, with particular reference to the College objects,14 the College Practice Guide,15 and the College’s Mission and Vision.
The Physician’s Role
As a health-care provider, the physician’s role is to provide quality care to patients and meet the evolving standards of the profession, no matter what tools, processes or resources are used.
With respect to eHealth, this includes:
Monitoring, responding and adapting to the changing eHealth environment by committing to lifelong eHealth learning;
Demonstrating eHealth literacy, which is the awareness of and ability to proficiently use relevant eHealth tools, technologies, processes and resources that facilitate best practice and the provision of quality care;
Using eHealth for the benefit of patients, individually and collectively, where appropriate, in a way that ensures patient confidentiality, protects the doctor-patient relationship and maintains public trust in the profession; and
Guiding patients, families and colleagues to high quality eHealth resources, wherever possible.
These are not new roles for physicians. Physicians use information management practices and strategies every day in order to provide patients with quality care.
The College Practice Guide and CanMEDS16 roles already articulate the principles of the profession and competencies for physicians, including demonstrating lifelong learning, using best available evidence and practices, sharing knowledge, reducing errors and collaborating with others.
eHealth Literacy will enable physicians to demonstrate these competencies and meet professional expectations in an eHealth environment.
Our Partners’ Roles
eHealth adoption and use are not solely a physician responsibility. There is a role for multiple partners – other health-care providers and regulators, system vendors, government, eHealth Ontario and others – to facilitate eHealth adoption and use to support quality patient care.
Our health-care system partners’ roles are to:
Recognize that eHealth solutions must be developed in compliance with existing professional standards, regulations and legislation;
Engage the College in a manner that allows it to fulfill its regulatory duty to protect the public interest, no matter which eHealth technologies are used;
Support the availability and future development of clinically useful and functional systems, those that are robust, flexible, upgradable, interoperable and able to effectively interface with
other systems, regardless of size or scope;
Support the development of systems that make information available17 to patients and other health-are professionals, as appropriate; and
Communicate with physicians about new systems, with clear information about benefits for patient care and efficiency, and offer initial training and ongoing support.
eHealth development and implementation continues to have a significant impact on the practice of medicine. As the regulator of physicians in Ontario, the College has a critical role to play. The College is committed to collaborating with partners to ensure eHealth development and implementation moves forward effectively.
The College anticipates that the role of physicians will change as the eHealth environment changes. The vast majority of physicians will adopt eHealth technologies that enable them to provide better, more efficient care to patients.
eHealth will continue to evolve, as electronic data management systems change, patient data repositories grow and health care processes change to take advantage of new tools.
As eHealth evolves, patient expectations and involvement in eHealth will also change. Some patients are already using eHealth technology and/or PHRs to access information and manage their health data.
The College anticipates that professional expectations will change as well. As key patient data repositories become available to physicians electronically, the College sees a future where eHealth connectivity will be required for physicians to practice effectively.
It is the College’s hope and expectation that in time, a statement about eHealth will be unnecessary, as eHealth will become an integral part of the practice of medicine.
1. Privacy protections are set out in the Personal Health Information Protection Act, 2004 (PHIPA). Confidentiality expectations are set out in the College’s Confidentiality of Personal Health Information policy. For the purposes of this statement, the use of either term will be assumed to include both sets of obligations.
2. Via EMR, web portal or other mechanism. Currently, some of this information (like laboratory results) is already available to some physicians.
3. …with technical functionality such as remote access, concurrent access, enhanced security controls, data backup and recovery, search capability and other base functionality that information technology enables. College of Physicians and Surgeons of Alberta eHealth Vision Statement, 2012.
4. CPSA eHealth Vision Statement, 2012.
5. College policies set out expectations for the ethical and competent physician. College statements set out a general position, usually on a system or self-regulation issue. Statements indicate how existing policies apply in particular circumstances.
6. CPSA eHealth Vision Statement, 2012.
7. eHealth Ontario.
8. Decisions about what health-care providers will have access to the EHR have not yet been made in Ontario.
9. US Department of Health & Human Services – EMR v. EHR – What is the Difference?, Jan 4, 2011.
10. Tang, P. et al; (2006). “Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption”. JAMIA 13 (2): 121–126.
11. CPSA eHealth Vision Statement, 2012.
12. For example, annual survey, complaints or assessments.
13. For example, College policies on Telemedicine, Medical Records, Prescribing Drugs and Test Results Management.
14. To develop, establish, and maintain standards and programs to promote the ability of members to respond to changes in practice environments, advances in technology and other emerging issues. RHPA, s3 (1-11).
15. The Practice Guide: Medical Professionalism and College Policies, September 2007.
16. CanMEDS 2005 - Royal College of Physicians and Surgeons of Canada (RCPSC) and CanMEDS - Family Medicine - College of Family Physicians of Canada (CFPC).
17. Accessible, transferable and portable.