Electronic revolution in health care

TheStar.com – Opinion – Electronic revolution in health care
March 11, 2009.   Carol Goar

The phone call that propelled him – and Ontario – into the era of electronic health records came out of the blue, Andrew Szende recalled.

It was November of 1998. He was working as a health-care consultant at the time. He’d spent 10 years as a senior provincial bureaucrat and 19 years as a reporter at the Toronto Star. He wasn’t looking for another career change.

He picked up the receiver. It was Brendan Gibney, vice-president of information and diagnostic services at the Hospital for Sick Children. “We’re going to set up an electronic health network,” Gibney said. “Would you be interested in being chief executive officer?

Szende was taken aback. “I can barely turn on my computer.”

“Don’t worry,” Gibney told him. “We have techies. We need someone who can turn the dream into a reality.”

Dubious but intrigued, Szende agreed to accompany Gibney to Dayton, Ohio, where an early prototype was in operation. It was rudimentary, but impressive.

“We did a lot of talking on that trip and at the end, I agreed.”

A few months later, the Electronic Child Health Network (eCHN) was launched. Its debut was quiet. Most Ontarians had barely heard of computerized medical records. Few policy-makers recognized the potential.

Last week, eCHN celebrated its 10th anniversary. It is now hailed as the model for a comprehensive provincial system of electronic health records. It covers every region, encompasses 100 hospitals and includes the medical histories of 1.2 million children.

Using a hand-held computer, a pediatrician in Orillia can follow a patient’s progress at Sick Kids’ and provide prompt, appropriate follow-up. Using a desktop screen, a nurse-practitioner in Thunder Bay can show a couple an image of their child’s brain scan.

Access to up-to-date information eliminates guesswork, reduces delays in treatment and lowers the risk of adverse drug reactions. It allows all the doctors, nurses and therapists working on a child’s case to see the big picture.

The database is still a work in progress. Children without hospital records aren’t included. Most physicians in private practice aren’t part of it. And 50 or so hospitals have yet to be connected.

But what began as a pilot project linking five sites – the Hospital for Sick Children, Rouge Valley Health System, St. Joseph’s Health Centre, Orillia Soldiers’ Memorial Hospital and St. Elizabeth’s Care Health – has evolved into Canada’s first province-wide electronic patient network.

Szende sees no serious technical impediment to bringing in all Ontarians. The challenges would be political, he says.

Adults are more protective of their privacy than children. Scaling up the system to serve 13 million people of all ages would be expensive. (The children’s network cost $60 million.) And bringing 27,000 doctors into the fold would require a prodigious effort.

“It’s doable and it’s desirable. But I don’t know when or how it’s going to happen.”

Looking back, he wishes Gibney, who died last June, had been hailed for his pioneering role. He provided the vision. He provided the impetus. He provided the technical know-how. “He was the shyest person imaginable. He didn’t want a public profile.”

Looking ahead, he wishes governments – Ontario’s in particular – would put some muscle behind the initiative. So far, the province has been a passive enabler.

After a decade at the helm, Szende still doesn’t consider himself a computer geek. He knows how to talk about the technology intelligently and demonstrate its benefits effectively. But he lets his team of 40 young, mostly foreign-born, technical experts look after the nuts and bolts.

He looks forward to the day when every Canadian will have an electronic health record. He likes the idea that Ontario’s children are leading the way.


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