Forging ahead with electronic health records

Posted on November 27, 2009 in Health Debates – Opinion/Comment – Forging ahead with electronic health records
Published On Thu Nov 26 2009.  Tom Closson President and CEO of the Ontario Hospital Association

The digital exchange of health information (often called electronic health records or EHRs) is essential to transforming Canada’s health-care system. Unfortunately, it appears that governments may be quietly re-examining their commitment to creating EHRs as they look for ways to reduce public spending in the wake of large, recession-fuelled deficits. Our advice is that we must continue to move forward.

Jurisdictions that have created EHRs know that the benefits are not hypothetical. Better information exchange between providers is reducing medication errors, improving patient referrals and follow-ups, and empowering patients to be more involved in their own care. These are areas where Ontario woefully underperforms today. With the help of EHRs, we can improve Ontario’s health system performance.

Health systems with EHRs share two things in common. First, their governments made achieving an EHR a priority. Second, they recognized that, though difficult and expensive, EHRs are essential to health system transformation. These governments also kept their eye on the EHR objective despite the challenges and setbacks often met along the way.

It is true that eHealth Ontario, the provincial agency tasked with creating EHRs, has been severely criticized for its performance. It appears that eHealth Ontario’s new leaders have learned a lot from that experience, and are applying those lessons today. But let’s set aside any views on the agency for a moment.

In Ontario, there are actually many success stories when it comes to the use of information and communication technology in health care. Improving remote and rural access to urban-based specialists through one of the most advanced telemedicine networks in the world, and the widespread use of picture archiving technology (PACS) to share diagnostic images like CT scans are major successes. Also, Community Care Access Centres and a number of hospitals have implemented local EHRs.

In Ontario, the most successful eHealth projects are built on the strengths of local initiatives and local expertise. With PACS, eHealth Ontario and Canada Health Infoway (CHI), the national agency that funds EHR-related projects, actually left technology implementation to hospitals. The two agencies acted as “strategic investors” and flowed “strings-attached” funding only after the projects’ deliverables were completed.

Expanding this approach to other EHR applications would allow us to implement technology in bite-sized chunks, leverage existing local investments that are in touch with the needs of front-line doctors and nurses, and improve patient care faster than if we waited to deploy a fully developed system. The strategic investor approach also greatly reduces the significant risks that too often plague centralized, government-delivered, “big bang” approaches to technology.

EHealth is vastly more complicated than simply uploading out-of-the-box software. It involves rethinking many aspects of how health-care professionals work and, although common standards are required, it needs to be tailored locally to the needs of people working on the front line. The closer that eHealth implementation is to the on-the-ground problems it is trying to solve, the more successful it is going to be.

The Ontario Hospital Association believes that a strategic investor approach for eHealth Ontario is the best way to move forward. When it comes to electronic health records, Ontario needs a vision of what it wants to achieve and it must continue to invest aggressively. But the path to success is actually to think small and act locally.

Recently, Auditor General Sheila Fraser released her value-for-money audit of Canada Health Infoway (CHI). For eHealth advocates, the audit was good news; the auditor found that CHI is well-run, with good oversight and management controls in place. It also confirmed the basic strength of the strategic investor model. Ontario’s positive, but still limited, experience with the strategic investor model, combined with the government’s stringent new procurement and oversight rules, should help reassure skeptical legislators and taxpayers that with this approach Ontario can reach the objective of building an electronic health record for all Ontarians.

There is no doubt that Canada and Ontario are facing significant financial challenges. But at the same time, EHRs are the foundation of an effective and efficient health-care system so we must ensure their creation. Over time, better patient care and improved health system efficiency will more than exceed the initial cost of the strategic investment.

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