Why isn’t Ontario’s HRM getting better faster?

“Use and growth of HRM has led to challenges.” So said Neilashi Gunanayagam at last week’s OntarioMD’s Digital Health Conference 2024. She’s the product manager, product and service management at OntarioMD.Indeed, HRM or Health Report Manager, which enables clinicians to securely receive patient reports electronically into their EMRs from participating hospitals and specialty clinics has grown rapidly over the past 15 years.But physicians continue to have concerns about the volume of reports received, duplicates and overly lengthy reports and wonder: why aren’t the problems being fixed faster?“I want to start off to say: I’m a clinician, I use HRM and I feel your pain,” said Dr. Sharon Domb, a FP and a peer leader with OntarioMD. She said they aren’t making excuses but reminded clinicians how little info they got in the pre-HRM days. “Now it feels like we get way too much information,” said Dr. Domb, who is also the Physician IT lead at Sunnybrook Family Practice. She said recently she received 12 ECGs on an admitted patient. But the reason improvements aren’t happening faster “is because HRM doesn’t exist in isolation,” she said. HRM Task ForceIn 2022, OntarioMD formed the HRM Task Force to address the challenges including:high volume of reports duplicates PDF reportsnon-standardization in categories of reportslengthy reportsreceiving locationNow the HRM Improvement Recommendations Advisory Committee, co-chaired by OntarioMD and Ontario Health, is looking at strategies to speed the implementation of recommendations and determine which organizations can lead and assume accountability for specific actions. The two panellists talked about ways to improve things but also tried to give some context about why this is so difficult. “I don’t know if any of you have had the experience of receiving a very lengthy report from a large downtown Toronto hospital,” Dr. Domb said. “I received one a couple of months ago and it was 14 pages long full of colonoscopy images of my patient and it was too large to even go into HRM. I rolled my eyes.” She said she contacted the hospital and was told she could login involving a different system to see the hospital said: “This isn’t all about you. This is how we track our reports and we need to keep the pictures for the colonoscopy for our records.”She added: “The hospitals themselves don’t have a motivation to fix some of this other than all of us complaining . . . we don’t have one institution that is responsible.”Pilot studiesBut pilot studies are looking improving things like labelling so an image isn’t just labeled “X-ray” and handling clinic’s getting fax duplicates because the sending facility doesn’t realize the clinic is on HRM. The two panelists also talked about initiatives like preference management. Dr. Domb said the goal is that there is going to be something you click on that will say, “I want to receive this report and I don’t want to receive this.” An audience member asked if a clinic opts out is that communicated back to the sender and does that affect liability? Gunanayagam said the senders are informed but the rollout of this is going to be complex because clinicians may make assumptions about and things could get missed. Gunanayagam also said the notifications opt-out pilot has seen more than 5,000 notification messages suppressed for the 110 clinicians who opted-out of receiving them, from July 27 to today. It was also noted that a group of 10 clinicians in the Ottawa region chose to re-activate HRM when the pilot went live, as it helped reduce the overload of notifications received.

Why isn’t Ontario’s HRM getting better faster?

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