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Going digital? Let the government pay

Don’t miss out on valuable subsidies

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.

Click here to read the rest of this article, including a province-by-province guide to EMR subsidies, from the current issue of .

Vacation denied: 29% of MDs can't find locums

The Canadian Medical Association has reported some new numbers on locum use from the 2007 National Physician Survey.

According to the survey, 29% of doctors wanted to get a locum to come in and cover their practices for a time but were unable to find someone willing to do so. Unsurprisingly, therefore, nearly half of physicians said they were dissatisfied with the availability of locums.

"As a profession we should be worried about that," said CMA president Dr Robert Ouellet.

One solution, proposed by the CMA in 2003 but still not achieved, is to create a licence to practise for locums that would enable them to move from province to province without regulatory hassles.

You can read the CMA's full release here.

Want to know where to look to try to track down one of those elusive locums? Earlier this year Parkhurst Exchange published an article I wrote called "" that might give you some ideas.

Mounties bust Montreal counterfeit pharmaceuticals network

In case you weren't convinced that counterfeit drugs are a big problem in Canada, maybe this will change your mind.

The photo above depicts some of the more than 15,000 counterfeit pills RCMP officers seized on Thursday from seven Montreal locations after a major, 18-month-long investigation, which also resulted in nine arrests.

Drug counterfeiting is an area of concern not only for the police but also for Health Canada officials and physicians, and a large portion of the concern arises from the growing popularity of the internet. In response to the RCMP's of its sting operation, Health Canada issued a reminder to Canadians about the risks of purchasing drugs online. "If you order from these sites, you may get counterfeit drugs that may contain the incorrect dose, the wrong ingredients, dangerous additives, or no active ingredients at all, which could result in potentially serious health risks." Irregular dosages and unadvertised ingredients and additives were in the counterfeit erectile-dysfunction pills seized in Montreal. "Even if these drugs do not harm you directly or immediately, your condition may get worse without effective treatment," Health Canada also warned.

Much of the problem stems from the fact that, in recent years, patients have become increasingly reliant on the internet to diagnose themselves and even to obtain drugs. While none of last week's raids targeted counterfeiters who were distributing via the internet, RCMP spokesperson Sgt Luc Bissette told Canadian Medicine, "There are ongoing investigations into online distribution" but he couldn't discuss details because they are still underway. "This time we hit the stores," he said. "Maybe next time we'll hit online."

The seriousness of the dangers posed by the growing online market for counterfeit drugs was made manifest in December 2006 when British Columbia resident Marcia Bergeron became the first person definitively shown to have been killed by fake drugs bought online. After Vancouver Island regional coroner Rose Stanton filed her report the following summer, she permitted to take a look at the document, including the toxicology figures. I in the National Review of Medicine: "The Burnaby, BC, lab found diphenhydramine (an OTC sedative), acetaminophen, mirtzapine (a prescription antidepressant), dextromethorphan (an OTC cough medicine) and methocarbamol (an OTC muscle relaxant). But most shocking were the dangerously high levels of metals, including aluminum (15 µg/g), phosphorus, titanium, tin, strontium, arsenic and other metals in Ms Bergeron's liver. The level of aluminum alone was 15 times higher than what's considered normal."

If that's not evidence enough to convince doctors that their patients could well be be at risk of serious injury as a result of fake drugs distributed online -- well, I'm not sure what else to say.

When I wrote that article in 2007, Dr James Wright, a University of British Columbia professor of internal medicine and pharmacology provided some excellent advice. With the government struggling to keep up with the counterfeiters, he said, physicians must take more responsibility for protecting their patients from this threat. "We are not very good at asking patients what medications they are taking other than what we are prescribing," said Dr Wright.

That advice remains as true today as it was then. Last week's RCMP raids in Montreal should not only remind patients of the risks of fake drugs bought online but should also tell doctors that the problem is likely with us to stay.