Most other industries would soon automate in similar ways and later make their services available online, meaning Canadians today can use their home computer -- or even their cellphone -- to do everything from book a vacation to download a song to find a date.
More than 30 years after those first ATMs showed up, however, health care -- perhaps the economy's most important sector -- has yet to catch up with even the 1980s IT revolution. The eHealth scandal that blew up in Ontario this week, taking down a Cabinet minister in the process, was a sad reminder of how far this country is from a widespread move to electronic health records, despite a consensus that the shift is desperately needed and the fact billions have been spent on the idea.
The vast majority of the 100 million doctor exams, half-a-billion lab and imaging tests and 382 million drug prescriptions every year continue to be documented in handwriting -- much of it barely legible -- according to Canada Health Infoway, a federal-provincial agency.
It all begs the question: why is this country so far behind in digitizing medicine, especially when many other industrialized countries are surging ahead?
"If other regions of the world can do it, what is our problem?" asked Harvey Skinner, dean of York University's health faculty. "The failure is really fundamental leadership from the top down."
The goal seems simple enough: Harness technology so that every patient's records are in electronic form and can be accessed by any health-care professional who needs to see them -- from the family doctor to the hospital nurse and pharmacist.
Studies have catalogued a slew of benefits. One is patient safety -- eliminating the errors inherent in handwritten prescriptions, notes and test results. Another is cost savings, gained partly through more efficient use of health workers' time, such as the doctor who can call up a new patient's history quickly on her laptop, rather than conduct a lengthy interrogation.
Denmark, Israel, New Zealand, Australia and Great Britain are among the countries that have made significant progress on automating health care.
Why is the vision still years from reality here? Experts cite a lack of political will, a reliance on private consultants who seek out the most cutting-edge technology rather than simple, easily workable solutions, and individual doctors who see the costs of going electronic but not necessarily the benefits.
But academics and other researchers stressed this week that the Ontario scandal and other obstacles should not distract governments from pushing ahead.
"We need digital records," said Kevin Leonard, a professor in the University of Toronto's health policy department. "We can't continue to fund the system the way it is today. This is not rhetoric, this is not fear-mongering. In 10 years from today, if we don't act, we won't have what we have today, because it will cost too much."
Experts in a variety of fields have talked about the importance of electronic medicine for at least two decades. Governments began working on the file in earnest in the 1990s, and the process accelerated in 2000 when the federal government set up Canada Health Infoway, which reports to both federal and provincial health departments.
There are some success stories. They include B.C.'s PharmaNet system, which allows pharmacists and doctors to tap into a patient's medication history electronically; a network that shares medical files between Ontario's children's hospitals; and PACS, a system for transmitting MRI and other diagnostic images from hospital to hospital and doctor to doctor.
The projects are isolated, however, and Infoway reports that the electronic records process is still just 17% done. It predicts completion by 2015, an estimate many consider overly optimistic.
One drag on the process has simply been the scope of the enterprise, which involves wiring together hundreds of hospitals and thousands of doctor's offices. Those hospitals all have legacy computer programs and moving them over to new systems that can be networked with the rest of health care is pricey and cumbersome, said Prof. Khaled El Emam of the University of Ottawa, the Canada research chair in electronic health information.
"It does take an extremely long time and it is extremely difficult," said Dr. Simon Eccles, medical director of the U.K. agency that runs that country's computer-health initiative, in the works for two decades.
Some also see an over-reliance on outside consultants paid by government. The Ontario Auditor-General's report that investigated contracting irregularities at the provincial eHealth agency said experts-for-hire at one time outnumbered provincial officials working on the file 10-to-1.
Technology consultants tend to push the most cutting-edge systems, even if something more basic could be implemented sooner, said Prof. Skinner. "A (lesser) technology [that is already] implemented is way ahead of the best technology sitting on the shelf."
But perhaps most important to expediting electronic records is motivating individual doctors to invest in automating their offices, experts agree. Prof. Roybn Tamblyn of McGill University estimates the price tag at $45,000 per practice, with a 30% drop in productivity while implementing the new system.
What is needed are incentives for physicians to undergo the transition, like the extra fee that Saskatchewan pays doctors who document their cases electronically -- or an Alberta program that offered funding and professional help to MDs who went digital, said Dr. Jay Mercer, an Ottawa physician who has automated his office.
The payoff, even before that wired clinic is plugged in to the rest of the system, can be huge, he said.
"It gives me more time to focus on the patient, it dramatically changes how effectively I can manage information," said Dr. Mercer of his own experience. "It has fundamentally changed the practice."
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Autor(en)/Author(s): Tom Blackwell
Quelle/Source: National Post, 09.10.2009
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