Summer 2024 (Volume 34, Number 2)

The Great Debate 2024
Be It Resolved That EMRs Save Time for Healthcare Providers & Improve Quality of Care

By Volodko Bakowsky, MD, FRCPC, on behalf of Tom Appleton, MD, PhD, FRCPC; Jill Hall, BScPharm, ACPR, PharmD; Steven Katz, MD, FRCPC; and Dax Rumsey, MD, MSc, FRCPC

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The Great Debate team (from left to right): Dax Rumsey, Tom Appleton, Volodko Bakowsky (chair), Jill Hall, and Steven Katz.

One of the highlights of the CRA Annual Scientific Meeting is the Great Debate. The 2024 installment of the debate did not disappoint. The greatest minds in Canadian rheumatologic care once again engaged in an intellectual pugilistic slugfest. Mercy was seemingly nowhere to be found.

Jill Hall and Steven Katz argued in favour of the motion, while Dax Rumsey and Tom Appleton spoke vehemently against it.

“Team For” established early on that the teams were differentiated by geography, and that the East side had a wannabe westerner in its ranks, as Dr. Rumsey now works in Edmonton. They didn’t stop there – next it was pointed out (with irony that silenced the crowd) that Dr. Appleton was named the Ontario Rheumatology Association (ORA) Rheumatologist of the Year in 2023, partly on the basis of his work with digital tools that integrate with EMRs. Ouch!

Arguments are briefly summarized below:

“Team For” noted that electronic medical records (EMRs) increase efficiency and offer improvement in various domains — prescriptions, templates, customized tools, improved legibility, faster communication and increased ease of tracking clinical changes over time. EMRs can be utilized to collect useful data that could lead to improved quality of care — for example by tracking wait times in response to system changes or innovations, as was demonstrated in Edmonton by Dr. Katz. Finally, the results of a CRA survey on EMRs was presented indicating that >70% of respondents were satisfied with their EMRs. Did that mean that the debate had already been won?

“Team Against” certainly didn’t think so. The unwieldiness (yes, it’s a word!) of many EMRs mandates an inordinate number of clicks and prolonged screentime, taking caregivers away from face-to-face care and contributing to burnout. EMR development is fraught with difficulty getting it right, as evidenced by the 1-billion-dollar Ontario eHealth scandal. Furthermore, EMRs that are poorly designed increase inefficiencies. EMRs also potentially result in loss of privacy — data breaches, cyberattacks, phishing and the risk that “Big Brother” will use them to collect data on caregiver performance to our own detriment. It was pointed out that the distinguished rheumatologists whom we all know and love all learned their craft at a time that preceded EMRs. Clearly, EMRs are unnecessary for the delivery of outstanding clinical care and academic productivity.

There were several lighter moments as well. Dr. Rumsey’s children sang a heartbreaking ditty about the plight of the lumberjacks. Paper is made from trees and trees require lumberjacks! “Team Against” tried to drum up sympathy by having Dr. Appleton wear a neck collar due to EMR-induced muscle tension. Not to be outdone, “Team For” retaliated with a cover song from the movie Barbie, about the tragic future of a no-longer-needed pen.

Alas, debates must always end, and there must always be a winning team. This year the “For” side dominated the vote and were crowned winners for 2024.

Volodko Bakowsky, MD, FRCPC
Interim Division Head/Chief,
Associate Professor, Division of Rheumatology,
Department of Medicine, Dalhousie University
Halifax, Nova Scotia