Health-care pros trampled in technology stampede

TheStar.com – Opinion – Health-care pros trampled in technology stampede
June 19, 2009.   Peter Vaughan, former CEO of the Canadian Medical Association and former president of WebMD Canada

In the wake of the Ontario eHealth revelations of exorbitant consultant fees, the elephant in the room is the army of technology industry insiders and consultants clamouring to provide services, advice and “solutions” to provincial governments and their progeny.

A pan-Canadian electronic health record sounds like a no-brainer. Health is a knowledge- and service-intensive business, so information technology should be able to organize wait lists, streamline services, improve efficiency and reduce medical prescription errors. It could ultimately reduce costs, maybe even as much as $6 billion according to Canada Health Infoway, the federally funded not-for-profit set up in 2000 to dole out cash for health information technology projects across the country. Yet only 23 per cent of Canadian physicians use some kind of electronic health record.

Lots of technology has been purchased, coffee and doughnuts consumed, and in some areas there have been sporadic successes. But overall, the vision of a national connected health record is still a mirage, a distant vision hampered by a critical failure of imaginative leadership at all levels and a blatant disregard of the needs of users: front-line health-care providers (doctors, nurses and others).

Harried CEOs, administrators, health information technocrats and their IT industry grease-the-skids consultants have all tried to force a square peg into a round hole. When it requires a doctor or nurse to spend more time doing administrative tasks such as entering information than it did before, it is no wonder there has been resistance to the adoption of health IT.

Physicians and nurses keep telling consultants they want to deliver health care, not become administrative assistants. Consultants talk about “change management”; health-care workers go back to taking care of sick people and a mountain of paper. The industry consultant’s answer is to hire a consultant to try to convince clinicians they need to change the way they work to meet the needs of technology. Doesn’t that sound like GM telling you to buy a Hummer when you just want a cost-effective way to get to work. The market isn’t stupid; neither are health professionals.

Many physicians, especially younger ones, are extremely frustrated by the lack of progress on electronic health records. Older clinicians and administrators are tired of the vapourware and Tower of Babel operating systems that can’t speak to each other and add layer upon layer of competing corporate technology interests. In the age of Twitter it seems unbelievable that something health IT insiders call “intra-operability” is guaranteed to keep consultants going for many years to come.

Because health care is a complex mosaic of cottage industries, there is a tendency for overburdened provincial governments to disregard those who understand the complexity of service delivery – clinicians – in favour of consultants with profound connections to government or technology vendors. It’s no surprise that Canada’s health IT adoption rates are among the lowest in the Western world.

Millions upon millions of dollars go to the health IT vendor businesses and their consulting spawn. Every day consultants desire to be introduced and connected so they can get into what is perceived by the management consultant industry as a cash cow, overseen by the federal mother of all IT cash cows, Canada Health Infoway.

The segregated, top-down approach to health IT is a flawed model. Because clinicians are at the heart of clinical work, they must be at the heart of health information technology innovation and governance. This is part of a much larger and even more needed debate around clinical governance in the Canadian health-care context. Recognition of this shift by policy-makers, managers and clinicians is fundamental. There is a huge gulf between managers and front-line clinical staff, and an even greater distance from hawkers of health IT “solutions” and front-line clinical staff.

In many cases where there have been health IT successes it has been because front-line staff themselves have seen the benefit of the iPhone or other web-based products to save time and improve patient care by accessing information when and where they need it.

The other flaw in the model is the management of health services delivery. Over the past two decades, clinicians have, with very few exceptions, systematically been pushed out of managing health-care delivery systems. However, a 2009 study by McKinsey and Company suggests that high-performing health-care organizations have adopted a distributive leadership model. From managed-care giant Kaiser Permanente and the Veterans Health Administration in the United States to parts of the National Health Service in the United Kingdom, organizations have made significant improvements because clinicians, particularly physicians, were a key part in shaping clinical services. A 2008 study by the London School of Economics found that organizations with the greatest clinician involvement in management performed twice as well as those with low levels of clinical leadership.

Front-line clinicians who focus on delivering and improving patient care can also lead in the application of health information technologies. This approach may yet realize the connected health record vision.

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