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Digitizing the health of a nation

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Electronic health records will improve the quality and accessibility of health care while reducing wait times and saving taxpayers money

Getting Canada on track to make electronic health and medical records more efficient has had its ups and downs, but to date, there are nearly 300 projects under way, which have already helped save money, speed up some processes and improve care.

It’s been about nine years since efforts to get each Canadian’s health and medical profile in digital format got a boost with the creation of Canada Health Infoway and $500-million in initial federal funding to invest in electronic health record (EHR) projects with the provinces and territories, which also support their own eHealth work.

But what is the EHR-for-every-person diagnosis and prognosis in Canada, which spends about $172-billion annually on health care?

“The power of modern technology” is already helping in improving quality and accessibility of health care while reducing wait times, improving information sharing, cutting down on drug errors and saving taxpayers money, says Richard Alvarez, president and CEO of Infoway, an independent, non-profit organization.

In an interview from his Toronto office, Mr. Alvarez acknowledges the lofty cost of working to create an EHR for every Canadian by 2016. Currently, as noted by the recent federal auditor general’s report, only 17 per cent of Canadians have one, well short of the goal originally laid out by Infoway. Auditor General Sheila Fraser also said while Infoway has work to do in improving its contracting and reporting practices, much has been accomplished since it was founded.

With more than $1-billion in federal funds received by Infoway since 2001, Mr. Alvarez says it is working on ways to make the EHR process more efficient, effective and transparent. While studies have shown the initiative will cost between $10-billion and $12-billion “when all is said and done,” it’s expected to save the health-care system between $6-billion and $7-billion annually, he said in the interview.

What really counts, he says, is that nearly 300 Infoway-funded EHR system projects are under way across Canada, with nearly half the money the organization has received so far already spent.

These projects include beefing up telemedicine across Canada. In Ontario alone, funding has helped expand Ontario’s network, through which 2,000 health-care professionals are delivering care to more than 660 rural and remote sites. As well, all communities North of 60 are telehealth-enabled or in the process of it, while work is on track to get 40 per cent of First Nations communities telehealth-enabled.

Those “success stories,” as Infoway calls them, don’t include the multitude of eHealth projects, such as the development of networks for information sharing across all disciplines, that are receiving provincial funding – efforts in some cases that have been overshadowed by controversy, which Mr. Alvarez says is unrelated to Infoway’s projects.

In Ontario, Health Minister David Caplan’s resignation earlier this year followed the awarding of hundreds of millions of dollars in untendered contracts to consultants. In B.C., the RCMP is investigating allegations of fraud and breach of trust connected to eHealth.

Still, the provinces are moving forward with an eye on innovation and cost-efficiency.

For instance, Artefact Informatique, the health division of LGS Group Inc., an IBM company, has signed a $3.6-million deal with the Agence de la santé et des services sociaux de Montréal to build a registry for digital medical images, so Quebec physicians will have quick electronic access to the millions of X-rays, MRIs and other medical images stored annually in three secure digital imaging repositories across the province.

In Ontario, Canon Canada Inc. has helped upgrade X-ray machines at Hamilton General Hospital by retrofitting them with DR panels (special digital technology panels) that cost about $159,000 each, compared with buying a whole new digital unit for between $250,000 and $300,000.

Mason Olds, senior vice-president and general manager of imaging systems for Canon Canada, says that of the about 10,000 DR panels manufactured by the company worldwide as of September, about 125 have been sold to hospitals and clinics across Canada.

“It used to be that when you needed an X-ray, it was always taken through analog technology; it was film-based technology and images had to be developed,” explains Mr. Olds from his Mississauga, Ont., office, adding that digital technology has evolved to the point where images appear on a monitor in just seconds. “The turnaround time is so quick and it eliminates so many steps.”

David Wormald, assistant vice-president, diagnostic services, with Hamilton Health Sciences, says the X-ray upgrades are just one of the moves helping Hamilton General move into electronic records.

Hamilton Health Sciences, comprised of six hospitals and a cancer centre in Hamilton and central-west Ontario, also recently completed an inventory of diagnostic imaging equipment across the organization, Mr. Wormald said in an e-mail interview.

Mr. Alvarez says part of the challenge of getting all Canadians on EHRs has been convincing physicians and clinicians that patient care will improve, that health-care professionals will better be able to do their jobs, and that there are opportunities to improve their income.

Since health care is governed at the provincial level, it’s up to provinces to get into the eHealth and EHR fold.

Only a handful of provinces has negotiated agreements to support doctors to bring EHRs into their offices, with the provinces paying about 70 per cent of the cost of upgrading doctors’ computer systems and offices and doctors paying the rest, according to a spring issue of the Canadian Medical Association Journal.

The same article notes some reasons high-tech practices aren’t being adopted yet, including because EHRs aren’t widely in place. For instance, in the case of “e-prescribing,” writing prescriptions electronically and sending them digitally, most pharmacies are not connected to clinics, hospitals and doctors’ offices in a secure electronic network and drug database – something EHRs would provide.

“Radiologists’ productivity has improved 25 per cent – they’re sold on [EHRs],” says Mr. Alvarez. “It’s the physicians, the clinicians you need to convince that this type technology makes sense. I believe in the last year there has been a tipping point – physicians are starting to believe this is the way to go, and the cost recovery is huge.”

Cross-Canada sampling

Infoway-funded electronic health records projects include:

Systems across Canada to transfer X-rays and other medical imaging to digital formats, expected to ultimately save $1-billion a year and increasing radiology productivity by 23 per cent.

Upgrading and enhancing B.C.’s PharmaNet system (giving pharmacists electronic access to health records), which helped prevent 2.5 million potentially dangerous drug interactions last year.

Funding Alberta’s WebSMR system, a simple, standardized means of capturing surgical medical reports, improving post-surgical reporting in most cases from a month to less than an hour more than 90 per cent of the time.

Helping in the implementation of the Ontario Drug Profile Viewer, which has been used in emergency departments in 177 hospitals, so health professionals can quickly access information for seniors. In September, the system was used to view drug information more than 95,000 times.

Marlene Habib

CTVglobemedia Publishing, Inc

© CTVglobemedia Publishing Inc. All Rights Reserved.. Displayed by permission. All rights reserved.

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