We'll close this trilogy with a discussion on whether Dr. J's requirements are realistic or otherwise; let's review them:

·         a connection to every hospital in Ontario (explicitly for her LHIN)

·         a Software as a Service (SaaS)/web-based EMR application

·         a reorganization of the way patient/operating data is managed in Ontario

The PRHC Improvement Plan (PIP) update was an agenda item at the July 20^th, 2010 CE LHIN Board meeting, and the discussion that ensued is also pertinent.

I was very encouraged by a comment from Ken Tremblay (hospital President/CEO) – he posited that healthcare has gone from a service to a knowledge industry.

I instinctively looked around the room as if I'd be able to tell from the various expressions, those who really understood the profundity of that statement.

Mr. Tremblay went on to suggest that healthcare has become very complex and his hospital needed not only to attract the best specialists in the various medical fields, but the infrastructure must also be in place for them to share information.

There's nothing being requested here that's beyond the capability of current technology, so one of the key enablers is quite possibly data management.

The visions put forward both by Dr. J and the PIP have me thinking: 

·         what if LHINs were to implement the “grocery store” model of data management by taking physical ownership of, and centralizing their respective patient/operating data? Authorized access to this repository would be via web-based tools. For example, Loblaws operates under many store banners in Ontario; I would confidently wager that the company has the technology in place to instantly determine the profitability of a bunch of bananas I recently purchased at my local grocery store – without such tools it would be difficult for it to remain viable in the long term; imagine all LHIN Corporate offices being in a similar position to determine the financial health of any/all of their institutions in real time!

·         What if LHINs were to encourage all primary healthcare providers operating within their respective jurisdictions to use the aforementioned repositories via a web-based EMR application? This could be reinforced with a program similar to that currently being implemented in the US

·         what if LHINs were able to mine their respective patient data repositories to ascertain any disease trends and act proactively to minimize the impact on local residents?

·         what if LHINs were able to offer local residents access to their personal health data via applications such as the TELUS Health Space PHR, in a bid to positively impact wait times and other initiatives?

·         what if LHINS were interconnected so that the mobility of Ontario residents' patient data or the sharing of summarized data was a secure and seamless process?

In spite of the fact that the above musings are evolutionary in nature and are by no means all-encompassing, action needs to be taken sooner than later.

A CMA poll has indicated that Ontario residents/Canadians are really concerned about the future of our healthcare system. As Anne Doig M.D. (outgoing president) states:

“It's true if we do nothing, then there will be a major crisis coming at us – we have the opportunity to […] prevent it from becoming a crisis."

Ok. I admit it. I’m scared. But not because we’re facing a huge challenge in our healthcare system – we’ve seen this coming for years.  No, I’m scared because we’re looking for scapegoats. Hopefully we begin to see a rapid change in both Canadians' mentality towards heathcare and in our practice of it.

Recent health headlines such as: Most Canadians fear for health system: report card, Canadians brace for higher health costs: poll and Survey finds most fear boomers will cripple health-care system scream warnings about Canadian’s fear that boomers will cripple our healthcare system over the next several years; and because aging seniors cannot afford care the result will be a toxic increase in tax hikes that our younger generations will have to endure.

According to an Ipsos Reid survey released this week by the Canadian Medical Association:

·   Four out of five Canadians believe that the demands placed on the health system by aging Baby Boomers will result in reduced access and lower quality care

·   75 per cent of respondents fear that growing health costs will result in significant tax hikes

·   And there is also strong support for user fees and having wealthy Canadians pay more out-of-pocket to help ease the burden of caring for seniors

·   Younger Canadians are willing to adapt to the pressures on the system by buying private health insurance to supplement publicly provided care

Obviously we are worried – and rightfully so.  But I would challenge the concept that one generation of individuals is going to be totally responsible for decimating our healthcare system.

Instead of looking for places to lay blame perhaps we should be looking at the failures in the system as a whole – not just those who use it.  According to a wonderfully written essay titled, “Spare the Policy, Spoil the Profession” by Steven Lewis (www.longwoods.com) “we owe the doctors of Canada a serious apology for spoiling a noble profession.  By kowtowing to organized medicine, we end up with collective agreements and policies that entrench the status quo and keep Canadian healthcare in the dark ages.”

Lewis goes on to make another truly poignant observation:  “We should apologize for letting doctors practice in the 21st century with the tools of Bob Cratchit.  Government’s sign collective agreements that condone quill pen medicine – we’re at the bottom of the G7 pack in the adoption of the electronic medical record. Quality improvement tools and techniques are optional. There is no obligation to undergo practice profiling and recertification. Most doctors have no clue about the quality and effectiveness of what they deliver – and those who think they do are almost certainly wrong. The inevitable results: medical practice harms 10% of patients in hospitals; there is routine prescribing of dangerous dosages and drug combinations to the elderly; there is widespread failure to diagnose and effectively manage the most common and straightforward chronic diseases; primary healthcare patients get all of the evidence-based care they need only about half the time; and the list goes on.”

Clearly change needs to happen quickly within the system in order for care to improve. We need to make significant investments in health information technologies to help reduce errors, improve the way information is used and to link care across the continuum. There must be a focus on implementing ePrescribing tools to reduce drug errors and interactions and we must collectively find ways to ensure all Canadians have affordable access to the medications they need.

All of us, at one time or another, will need to use our healthcare system – not just the Boomers. Governments, healthcare providers, clinicians and the private sector need to work together to find solutions to ensure the delivery of safe, high quality care now and for generations to come.

Let's continue our discourse around Dr. J's “must-haves”, with the second item, a SaaS or web-based EMR system.

As a bit of a backgrounder, we'll travel back in time to her university days – you see, web-based E-mail was unavailable and the only way to get access during her travels, was to dial-up the school's facilities; this more often than not turned out to be prohibitively expensive.More...

This blog post has been cross posted from www.healthcareguy.com. The original post appeared last November, in response to an article posted by SoftwareAdvice.com posing the following questions to its readers in a survey format: “Are more doctors buying electronic medical records than before? Or, has the Stimulus bill only brought out the tire kickers?“  While the survey results aren't scientific and it didn’t have enough participants to draw wide scale conclusions, the results do imply a general feeling of positive momentum towards the purchase and implementation of EMRs.

As an experienced healthcare IT professional I am very happy to see that people are looking towards EMRs and automation to improve healthcare staff productivity. However, I’d like to urge a bit of caution and be sure that buyers don’t jump into the market for the wrong reason. My rule about automation and insertion of software in any workflow process is simple: if you can’t repeat it, don’t bother automating it. 

More...

&q

On June 23rd the Commonwealth Fund issued a report that compared the healthcare systems of seven western countries based on data from patients&r squo; and physicians’ survey results on care experiences and ratings on various dimensions of care. 

The seven nations studied were Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States.  Here’s what they found:

More...