After a decade of false starts and spending scandals, Ontario's move from paper charts to electronic health records is still grinding on, but Dr. Gregory Rose is a few steps ahead of most physicians.
Rose, an infectious disease specialist, is among 240 doctors at The Ottawa Hospital who are the first in Ontario to be linked to provincewide databases that give them a more complete picture of a patient's health.
With the new system, Rose can use his computer to get near-instantaneous results of his patients' blood or urine tests, which are key for diagnosing infections.
Gone are the frustrations of waiting for lab reports to arrive by mail, or tracking down missing reports by phone, which can lead to tests being repeated that drive up health care costs and delay care for patients.
"It makes our jobs a lot easier," said Rose. "It makes our picture of what's happening with the patient a lot more clear."
And through a database that tracks the prescriptions of 2.8 million Ontario seniors and social assistance recipients, Rose can view the medication histories of at least some of his patients.
The information allows him to check for possibly dangerous drug interactions and choose the most effective antibiotics. It also takes some of the guess work out of understanding patients' health histories, which are typically based on their ability to recall every illness and treatment they have ever had.
Such information can be incomplete, especially when patients are ill, injured or in pain, said Rose. And yet a vast majority of physicians still rely on this kind of paper trail that can be misplaced, lost or unavailable in an emergency.
The push toward ehealth is part of a nationwide effort to create a comprehensive health profile that follows patients wherever they need care.
Officials say bringing patient records into the Internet age can contain costs and reduce the information gaps that can lead to medical errors, especially when patients move from one provider to another.
However, some U.S. and European studies have cast doubt on those claims. Earli-
er this year, the journal PLoS Medicine published a largescale review of more than 100 medical studies that assessed the impact of various ehealth technologies.
The review by British researchers found little evidence that electronic records, in and of themselves, improve the quality and safety of patient care.
In Ontario, the very mention of ehealth conjures up a scandal that forced the departure of several key players from the Liberal government. And eHealth Ontario, the government agency responsible for the modernization effort, has been criticized for lacking strategic direction, hiring too many consultants and spending $1 billion with little to show for it.
In his 2009 investigation of eHealth Ontario, provincial auditor general Jim Mc-Carter blasted the Liberals for exacerbating problems that began under the previous Progressive Conservative government.
Since then, a new management team has been installed, and agency officials say significant strides have been made toward creating an ehealth record for every Ontarian by 2015 - a deadline some critics view with skepticism.
To date, more than 7,300 physicians, of the 26,000 in Ontario, have been given funding to digitize the files of seven million patients.
The agency has also invested in regional projects, including Connecting GTA, which links most Toronto-area hospitals electronically, allowing them to share diagnostic images, lab results and patient health histories.
A limited version of this system exists in Eastern Ontario, where 11 of the region's 20 hospitals are able to share diagnostic reports and images. Another six hospitals are expected to have the same capabilities by the end of the year.
A provincial diabetes registry is also on the way, which aims to help patients with the disease better manage their medications, blood-sugar and cholesterol levels. Officials say the electronic registry would improve preventive care by alerting physicians to patients who don't take their medications as prescribed and reminding patients when it's time for another checkup.
The goal is to eventually link all the different building blocks - local, regional and provincial databases - into a health care version of the Internet.
To speed things up, eHealth Ontario has focused on building the computer networks and "bridges" that connect existing databases rather than designing an entire system from scratch, said Alice Keung, the agency's chief operating officer.
"Our strategy is one of 'don't unplug anything.' Don't ask people to change the way they work. Instead, we're bringing new information to their own (work) environments."
For example, The Ottawa Hospital was chosen as a test site because it already had a user-friendly ehealth system that could be plugged relatively easily into the provincial drug and lab databases, said Keung.
"This project is one of many examples of eHealth Ontario's strategy of working closely with local health providers to leverage existing technology assets."
The hospital has long had a partial ehealth system that stopped at its doors. Once a patient was discharged, hospital doctors could no longer track any followup tests or medications ordered by other physicians, leaving them with an incomplete picture of the health of patients the next time they returned.
However, that is finally changing as the hospital gradually moves to connect more of its ehealth systems with those of family physicians, said Valerie Gamache, The Ottawa Hospital's deputy chief information officer.
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Autor(en)/Author(s): Pauline Tam
Quelle/Source: Ottawa Citizen, 10.10.2011
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