Social Policy in Ontario

Losing track of big picture at eHealth

Posted on June 13, 2009 in Health Debates

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TheStar.com – Opinion – Losing track of big picture at eHealth: While MPPs squabble, Ontario patients suffer due to lack of electronic health records
June 12, 2009.   Michael Rachlis

With the headlines screaming scandal at eHealth Ontario and the media and opposition sensing blood, Ontario risks falling further behind on electronic health records.

Of course, I understand how people who are losing jobs and savings can be angry at the symbolism of consultants who make more than $300 an hour billing for muffins. And there has been a lot of money spent on electronic health records in the past without much to show for the expenditures.

But let’s remember that so far we have allegations. Consultants usually have legal contracts that include payment for food on the road. Dr. Alan Hudson, Sarah Kramer and her team were incredibly effective in their previous work at Cancer Care Ontario and the provincial wait times initiative. And they had already accomplished a lot in their first six months at eHealth, including launching a pilot project to track prescriptions for 80,000 patients in Sault Ste Marie and Collingwood. Finally, top-notch private sector IT people make a lot more than Kramer ever did.

Full disclosure: I have met Hudson and Kramer but never worked for or socialized with either of them.

Now let’s take a look at the bigger picture.

You need high-quality, integrated electronic records to run a safe, efficient health system. On a 1981 visit to a Havana community health centre I was struck that each doctor had a binder with lists of patients with different chronic diseases.

In what might have been an apocryphal story, a physician told me that in his guerrilla days, Fidel Castro saw a child die from asthma. Fellow guerrilla and physician Che Guevara informed Castro that the death could have been prevented with appropriate care prior to the attack.

With a voice swelling with pride, the doctor said that Castro had created a world-class health-care system. And El Commandante insisted on the regular follow-up of all patients with asthma and other chronic diseases to prevent unnecessary deaths, such as the little boy’s he had witnessed.

When I got back to my practice, I bought a binder and started keeping track of all my patients who needed routine follow-up. I discovered that I had more than twice as many patients with these conditions as I had suspected. My patients got better care. Probably some of them avoided heart attacks, strokes and kidney failure.

The following year, I visited Seattle’s famed Group Health Cooperative of Puget Sound. Established in 1948 and still run as a cooperative, Group Health has spawned innovation after innovation.

In 1982, they had a fully integrated electronic health record with terminals in every office hooked up to an IBM mainframe computer. The possibilities astounded me.

As I returned to my practice I thought it would be just a few years before I had an electronic system on my desk. It would track patients and automatically alert them and me about needed follow-up care.

According to the Ontario Health Quality Council’s annual report released Tuesday, 27 years later only 25 per cent of Ontario family doctors have electronic records compared with 50 per cent in Alberta and 98 per cent in the Netherlands.

It gets worse. Only 8 per cent of Ontario family doctors use their electronic records to follow up patients. Thousands of patients with diabetes and other chronic conditions are dying unnecessarily. Thousands of X-rays are being redone every year because the one done a few days earlier isn’t available. Castro would not be impressed.

Why do Ontario and Canada lag behind other jurisdictions? First, electronic health systems cost money. Federal agency Canadian Health Infoway estimates capital expenditures of $10 billion for an integrated health record for the country. However, to put this figure in perspective, Canada’s health system spends that every three weeks. No Martha, we shouldn’t put electronic records back on the shelf for another 25 years and spend the money on more doctors and nurses working in an uncoordinated, unsafe system.

Second, Americans refer to our medicare as socialized medicine. But we’ve really only socialized the funding. Most of Ontario’s 20,000 doctors are in private practice and Ontario’s 140-plus hospitals are still private, albeit non-profit, corporations with independent boards.

In the U.K., the government paid for the electronic systems in hospitals and doctors’ offices. Providers and practitioners had little choice about their systems. Doctors and hospitals can communicate with each other.

In Ontario, the government has balked at paying. More than a dozen systems are approved for doctors’ offices but most will be unable to communicate with the various systems being bought by hospitals, which in turn will be unable to communicate with each other.

Where do we go from here? Ontario and other governments have to suck it up and pay the money. Governments have to get together with providers and ensure nobody wastes money on any more systems unless they are fully interoperative.

Regarding the muffins at Tims, let’s allow the auditor general to do his good work. We need to ensure that every Canadian has a secure electronic record to keep their care safe and sustain medicare for the next generation.

Dr. Michael Rachlis is a health policy analyst and an associate professor at the University of Toronto.

 

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