As electronic medical records become increasingly commonplace in Canadian doctors’ offices, the old excuses about difficult, unreliable software have largely been proven spurious. But still most physicians have resisted switching entirely to digital. Why? The reasons are no longer functional — modern EMR systems are excellent, safe and easy for even basic computer users — but rather financial: the costs of EMR implementation and maintenance, and the requisite hardware, can easily run into the tens of thousands of dollars. Changing your whole charting process is hard enough. Changing your whole charting process and paying through the nose for the privilege? For a lot of physicians in private practice, that’s asking too much.

A consensus has emerged in the nascent EMR-adoption literature that the cost of setting up an EMR system may be the greatest barrier for many interested doctors. Mercifully, provincial governments have taken note and, over the last three years, many have created substantial subsidy programs to lighten the financial burden.

Alberta’s Physician Office Support Program (POSP) was the first out of the gates, in 2001, with government funding and joint governance from government and the Alberta Medical Association, and other provinces’ programs have followed Alberta’s lead. Eligibility requirements for POSP funding are relatively lenient, and are similar in other provinces: doctors must submit an assessment of their information-privacy plan, must do a certain minimum amount of billing, and must contract with an approved private EMR provider.

Selecting an approved provider is crucial. There are dozens of companies that produce EMR systems, some better than others, but only a handful have been evaluated, tested and approved in each province. For example, in Alberta, only three are eligible for funding at the moment, whereas in Ontario there are 15. You may not be thrilled with the choices, but if you live in a province that offers funding (Alberta, Ontario, BC, Nova Scotia or Saskatchewan) then you should stick to the approved-vendors list and take advantage of the subsidies, which vary from province to province but can be significant — from $600 to potentially more than $1,000 per month, and sometimes with hardware or start-up funding as well. Buying a cheaper or slicker but uncertified EMR system not only makes you ineligible for financial support but could land you in hot water later on if the market consolidates, as it almost certainly will, and your provider is subsumed into another or shut down. The companies selected by the provincial subsidy programs, while not always the most cutting-edge, are reliable, guaranteed to perform all the fundamental tasks you’re likely to need them to perform, and, perhaps most importantly, available to you on the government’s dime.

More information on the provincial EMR-subsidy programs

Ontario
For Ontario doctors, subsidies for electronic medical records and computer hardware come from the Physician IT Program.

Unfortunately, the program is currently designed only to aid primary care physicians who work in what are called “primary care renewal groups” such as Family Health Networks, which means a fairly large number of doctors don’t qualify.

Funding is available for practices that select from the program’s list of 19 approved EMR software packages (also called Clinical Management Systems, or CMSs) and the amount of money available is not insignificant. Eligible doctors can receive an initial grant of $4,500 and monthly payments of $600 for a period of three years, plus $2,500 when two-thirds of their rostered patients’ records have been entered into the electronic system – a total of $28,600 over three years.

A $2,000 grant is available to doctors who need to buy a computer, basic office software and a printer, and a practice management consultant is available free of charge to help in the process of installation and implementation.

Ontario’s subsidies are not just limited to first-timers: even doctors and practices that already have EMR systems up and running are eligible to apply for funding for their existing system or for money to make upgrades.

(866) 744-8668; Click here to visit the OntarioMD website: http://www.ontariomd.ca/portal/server.pt?space=CommunityPage&cached=true&parentname=CommunityPage&parentid=0&in_hi_userid=2&control=SetCommunity&CommunityID=477&PageID=0

British Columbia
BC’s Physician Information Technology Office, or PITO for short, operates the Implementation & Transition Support Program to provide financial assistance to doctors installing EMR software.

Any doctor who can demonstrate a clinical need for an EMR system and bills the government for at least $50,000 of medical services per year is eligible.

PITO funding is available for doctors putting in their first electronic medical records system or for doctors who want to exchange their existing system for one made by any of the five PITO-approved vendors.

The assistance amounts to 70% of the cost of the EMR system, to a maximum of $7,000 for installation costs, a maximum of about $7,500 in operating costs over the first few years of use, and a maximum of $4,900 for hardware including desktop computers, laptops, printers, scanners and more. Doctors are responsible for the remaining 30% of the expenses.

Doctors who participate in PITO will also receive access to the Ministry of Health’s secure, high-speed network and email system, which is necessary to use the PITO-approved EMR systems.

604-638-2946; Click here to visit the PITO website. http://www.pito.bc.ca/default.htm

Alberta
Alberta’s Physician Office System Program (POSP) was the first information-technology subsidy program for doctors in Canada when it began in 2001, and its success has influenced the way other provinces have developed their programs. Its challenges and struggles, however, have also influenced other provinces: in its early days POSP paid physicians to install any EMR system the physicians chose. After that policy became untenable due to compatibility problems, in 2006 POSP certified 12 systems and limited funding to doctors using those.

POSP funding provides reimbursement for doctors for 70% of the costs of their EMR and hardware needs, to a maximum of $35,000 over five years.

(866) 817.3875; Click here to visit the POSP website. http://www.posp.ab.ca/

Nova Scotia
The EMR element of the province’s Primary Health Care Information Management (PHIM) program really got off the ground last year when the new master agreement between Doctors Nova Scotia and the government established some sizeable subsidies to encourage doctors to go digital.

All doctors across the province are eligible to receive a one-time implementation grant of $5,300, plus $2,000 per year until the current master agreement expires four years from now.

A large portion of the subsidies consists of an unusual grant of $9,770, to be used to purchase a licence to use a specific internet-based (also called ASP) system made by a company called Nightingale, which has managed to obtain preferred status in Nova Scotia. Doctors who use one of the other two EMR systems approved in Nova Scotia – Clinicare or Practimax – will still qualify for the $5,300 and $2,000 per year, as well as an additional “utilization incentive” grant of unspecified amount set to be announced this September, but they won’t be able to take advantage of the money set aside to get physicians to use the Nightingale software.

Doctors and clinics will be responsible for buying hardware, paying for internet service, and for covering the costs of software support after the first year. But the province will pay for hosting services (data storage) and will cover the cost of an interesting and apparently popular initiative in which doctors who have already been using Nightingale’s software will be made available as tech support and practice management aides for clinics just starting up their EMR systems.

(800) 565-3611; Click here to visit the PHIM website. http://www.gov.ns.ca/health/eResults/default.asp

Saskatchewan
Sasakatchewan’s program, modeled after Alberta’s POSP, isn’t quite on its feet yet but much of the plan is already nailed down. Like in Alberta, 70% of the funding will come from the government, but in Saskatchewan the remaining 30% will be provided directly by the medical association, instead of from individual physicians or practices.

According to Roy Robb, the director of information technology at the Saskatchewan Medical Association, funding will be $500 per month plus one dollar per patient visit registered in the EMR software. That amount will eventually drop to $400 plus the dollar per patient, and then $300 plus the dollar per patient, as more parts of the system are brought online (and presumably those extra parts, such as hook-ups with laboratories to receive reports electronically, will save doctors time and money, making moot the need for the extra $200 per month). No word yet on how long the funding will be available for. In Saskatchewan, hardware costs won't be covered.

Four software vendors have applied for certification and the approval process is still underway.

(800) 667-3781; Click here to visit the Saskatchewan Medical Association’s website. http://www.sma.sk.ca/

Manitoba
Manitoba eHealth has approved four EMR vendors but doesn't currently offer subsidies for physicians to install their systems.

(204) 926-9000; Click here to visit the Manitoba eHealth website. http://www.manitoba-ehealth.ca/

Quebec, New Brunswick, Newfoundland and Labrador, P.E.I. and the territories

No subsidy or vendor-certification programs currently exist.