How electronic medical records affected one NWT patient’s care

The NWT’s electronic medical records system is “limiting healthcare providers from serving patients and aggravating patients going through this.”

That’s the view of Karl Johnston, who grew up in Fort Smith and went to school in Alberta before moving to Yellowknife seven years ago.

He’s been dealing with chronic nerve pain for several years. In 2021, after a day surgery, he had to return to the hospital five times because his stitches kept coming out. On each visit, he had to sit down and redo the intake paper by hand because “nothing is saved,” Johnston said. “The ER is not talking to general surgery.”

He argues the inability of the NWT’s current electronic medical records system to communicate between the territory and southern provinces, or even between different areas of the territory’s own healthcare service, is creating unnecessary challenges that make the lives of patients and providers difficult.

Though primary care providers broadly use the same digitized system, compartmentalization remains. Hospitals, for example, have digitized lab results and appointments, but charting – the documents that detail interactions with patients and their care – is still done on paper.

In June 2021, Johnston was referred to a specialist in Alberta. His specialist couldn’t get his records or diagnostic images from Stanton without them being sent by mail, with the images on a CD.

In an email seen by Cabin Radio, Johnston was told that the NWT’s health authority could take up to 30 days to get a CD ready and send it after he submitted a request.

Johnston queried that length of time. When he asked if there was a faster way to send the images, he was told by email: “Unfortunately, out-of-territory physicians do not have access to our program systems, nor do we upload to any outside parties. We also do not email images.”

Cabin Radio asked the Department of Health and Social Services whether ways of sharing medical records and images between healthcare providers in the NWT and Alberta have been upgraded since Johnston’s experience.

A departmental spokesperson said: “The NWT has both paper and electronic records and thus we use both for transferring information.

“NWT is modernizing information systems as part of the broader goal to create a more complete patient record and improve information sharing between providers and partners, while maintaining security and privacy.”

Last month, Cabin Radio reported that the territory’s medical records system will be replaced, at a reported cost of $20 million to $30 million, a few years after a 17-year-long rollout of the current system finally finished.

A contractor is set to be identified for the first phase of that work this fall.

A timeline for the replacement of the system, and a description of how a new system will more closely work alongside others such as those in the south, are not yet available.

Records associated with physician burnout

Johnston’s experience left him wondering why different areas of the healthcare ecosystem seemed incapable of “talking to each other.”

He stressed he has no criticism for the healthcare practitioners themselves.

“They’re great people. I feel like the system that they’re housed within, like the bureaucracy and the red tape … is affecting them just as much as it’s affecting patients,” he said.

“I want health providers to be able to be health providers and not be limited in how they provide health. It just seems like it’s a really aggravating process for everybody involved in it, patient and providers.”

A 2021 study that drew heavily on the experiences of NWT physicians found the use of electronic medical records was a factor associated with burnout among doctors in northern Canada.

The study noted that “tasks including rooming patients, entering labs into the electronic medical record, and cumbersome paperwork processes leave physicians feeling ‘over-stretched’ and ‘drained.’”  

Johnston wants to see a universal system that can be readily accessed by all practitioners in Canada, but an advisory body to the Public Health Agency of Canada reached a different conclusion in 2022.

Instead of recommending a single, Canada-wide system, the advisory body suggested that provinces and territories adopt common standards and health data architecture – the software approaches and guidelines that govern how data is stored and shared – which would enable them to move information more easily.

Until such recommendations are adopted, patients feel stuck in a system that doesn’t always work.

“I’ve just been going through this mess for so long, of bureaucracy and appointments and filling out goddamn forms,” Johnston said.

“You have to really drive your advocacy as a patient to fight for care.

“There’s something wrong here, and it’s not fair that northerners have to suffer because departments and territories and provinces don’t want to talk to each other.”

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