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| Going digital — Why does the future still seem so far away? | 2009-02-18 15:36:37 |
Going digital — Why does the future still seem so far away?
Have you ever wondered where all those notes your doctor scribbles in your medical chart end up? And what good they would be if you arrived unconscious at a different hospital where there was no record of your medical history?
At Toronto’s University Health Network (UHN), paper medical records once took up more than 40,000 square feet of storage space. The UHN serves one million patients at three different hospitals. Maintaining paper records — of patients’ x-rays, test results, medical histories and more, across all three sites — proved time-consuming. Doctors reported spending hours a day trying to track down patient records that would enable them to make critical decisions about their patients’ care. Often, paperwork was lost and tests had to be duplicated, wasting valuable time and resources, and making other patients wait.
But today, the UHN offers an electronic health record (EHR). It makes every piece of information on a patient, from all stages of their UHN journey, available quickly and easily. The EHR improves coordination of care, saves money, and lets nurses, doctors and other professionals focus on quality of care instead of tracking down information.
All around the country, health care professionals are seeing the benefits of shifting from paper records to an EHR system.
In 2007, community pharmacists in Sault Ste. Marie became Canada’s first to access lab test results, allergies and other vital data from the electronic medical records of 300 consenting patients enrolled in the pilot project. The EMRxtra program, run by Group Health Centre, is reducing the risk of drug interactions and improving patients’ safety by helping physicians, nurses, and pharmacists communicate quickly through electronic charts.
Meanwhile, at an acute-care hospital in Saskatoon Health Region, an investment in digital diagnostic imaging has meant that space once used to store thousands of film libraries has been transformed into an MRI clinic. Switching to the Picture Archiving and Communications System (PACS) enables authorized health care professionals to collect, store and distribute digital diagnostic images such as x-rays, ultrasounds, MRI and CT scans, no matter where the test is done or the clinician is located.
Research done for Canada Health Infoway (Infoway) reveals that digital imaging will generate up to $1 billion in health system efficiencies each year once it is fully implemented across the country. Projects already in place show many benefits — things like fewer duplicate exams and fewer patients moving from one facility to another. Most dramatically, digital imaging makes radiologists and technologists 25%–30% more productive — allowing them to see more patients, reduce wait times, and save the health care system hundreds of millions of dollars.
That’s just part of the approximately $7 billion in savings projected by Infoway once a pan-Canadian EHR system is in place. Infoway is the federal agency charged with realizing the vision of a cross-Canada health information highway and every Canadian with an electronic health record.
What will it take? $10 billion by 2016, according to Infoway, along with a lot of willingness and work. That $10 billion amounts to all of $350 per Canadian.
What do you think?
1) Should creating electronic health records for all Canadians be a public funding priority?
2) What is preventing us from getting these systems in place faster?
3) If you work in health care, has your workplace begun to use electronic health records? If so, what impact have they had? If not, what would it take to get them in place?
For more information:
Watch a video from the Health Council of Canada
o University Health Network streamlines care with electronic health records
| Your responses |
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| The future may be far but still acieveable othmanlatif Posted: 2010-02-15 14:52:30 I would totally agree with the 1st comment. I am providing some information I read in a research document about the comparison of EMR and PHR. And it was shocking to know how much work has to be done to achieve what has been discussed in the article. The report says; There are a total of 754 acute care hospitals that have not fully implemented a base of major clinical ancillary department applications (e.g., laboratory, pharmacy, radiology) to qualify for initial designation for implementation of EMR Adoption Model. This represents approximately 19% of the hospitals in the database. Most hospitals occupy the stage 1 and stage 2 levels of the EMR Adoption Model. The combined percentage of hospitals in these two stages is approximately 71%. At this time, there are only 414 US hospitals that are at the middle stage of the EMR Adoption Model. This shows the tremendous amount of work and investment that must be done by US hospitals to implement clinical systems to enable their participation in EHR initiatives. More importantly, further implementation of higher stage EMR applications will enable the reduction or elimination of medical errors, while providing the digital environment. The higher stages of the model represent the facilitation of not only improved patient care, but also improvements in efficiency and effectiveness with which patient care services are delivered by clinicians. Once the healthcare organizations are provided with these capabilities, the focus can be shifted on sharing patient care information among all of the healthcare stakeholders. Currently, the hype surrounding healthcare IT has the 'cart before the horse'. How can we discuss of EHRs, much less implement them, until we have implemented effective EMRs, no hospitals, but in all care delivery organizations including physician practices? I am associated with Global Patient Record (GPR) and we are also trying to help promote the awareness among the people about EMRs and PHRs. GPR has been providing solutions to improve patient care for over a decade. The philosophy is to lower the medical liability and costs associated with patient follow-up and to increase the cooperation between patient and the provider. It offers the GlobalPatientRecord to keep you (the patient) notified and informed as well as responsible for your health record. The mission is to help the patient to play an active role in managing one's own patient record, make better decisions when it comes time to have a health-related checkup, be informed when the medical results are available, be notified when one's health provider is trying to reach one, identify areas of potential health risk and provide solutions to prevent missed patient follow-up, improve communication between the patient and the healthcare providers, has access to accurate patient information instantaneously whenever needed. It is equally beneficial for patients and healthcare providers. Anyone can keep track of one's personal health record as well as one's <ahref="http://www.globalpatientrecord.com">patient record</a> with Global Patient Record. And one has access to it anytime and anywhere via medical records online. The future seems far but it is for sure that every one is trying it best to make it more healthy. Othman Latif http://www.globalpatientrecord.com |
| Progress is underway LF Posted: 2009-06-30 12:05:21 I work in
this field in Interoperability
â this is a big one. No one wants to put
in a system and then not be able to access their data or use it if the vendor
they chose goes under. There must be a
standard representation of patient data in order for this to work and there is
already patient data out there so it must be remapped (to a standard that hasnât
even been created yet). Either way,
interoperability will protect the investment in IT and allow for easier
data transfer. Doctors are
their own businesses â You cannot have digitalization and have everyone
connected if not all physicians have a clinical management system (computer
system to handle billing, scheduling and the patient medical data itself). Unless every clinic has one of these systems,
not everyone can have an electronic patient record. The problem is that doctors may not want to
bear the overhead cost of implementing these systems themselves. So they must be funded (this is happening). Making the
switch â Even if you are one of the doctorâs that are fortunate enough to have
received the first round of funding and can move your patients to an EMR, you
still have a lot of work to do. While
running your clinic and providing patient care, you will also be moving all of
your processes to the electronic world as well as some of your data. This probably means downtime for your clinic
and retraining your staff. This is very
challenging when this same clinic is still booking new appointments months in
advance as it is. Politics â
Different governments will have different ideas as to how to go about solving
these challenges. Programs already in
place could be scrapped. Healthcare is
typically provincial jurisdiction but a lot of the posts are for national
standards. Each province may have
different needs and goals for their patient records. Things are
not necessarily bleak. It is slow but
there has been progress, for example in |
| Information Systems PatrickLouch Posted: 2009-04-23 08:10:48 Anyone who knows anything about information systems knows that they are a pain. Hardware needs purchasing and maintaing; software needs purchasing, development, and customizationg; and every user (doctors, nurses, administrators, unions) needs to be on-board. Private-sector information systems developed over the last ten years are typically 200-300% over-budget. Public sector ones are even worse. Google "internal revenue service information system failure" to see how billions were wasted. This information system would be of benefit, but I think it's unfeasible now and too costly. Government first needs to reduce the power of the unions, then convince the CMA about the glories of IS, get the CMA to get all of its members to agree, then hire a brilliant project manager who's technically savvy, logistically savant, diplomatically sublime, and only needs a yoo-hoo once a week to keep going. Get all of this in place and then the system will probably only cost $15 Billion instead of $10B. Besides, 10% a year (1B/10B) under the most optimistic forecasts in the riskiest of projects is by no means an acceptable return. |
| CONTINUE EXPANSION OF SCOPE OF ON-LINE MEDICAL RECORDS WITH ACCESS RESTRICTED TO ATTENDING PHYSICIANS AND SPECIALISTS. Eric Odell Posted: 2009-03-27 12:45:19 Speedy access to treatment is enhanced when physicians have online access to diagnostic test and imaging results, referral and consultative notes, and other pertinent patient information. Much has been done in recent years but pulling the patchwork together initially within Regions, then Provinces, and ultimately Nationally, needs to be encouraged. |
| E-health blynn Posted: 2009-03-12 12:08:07 I agree as long as funding follows for all levels of care - i.e. computers, proper user-friendly programs, etc. Working in long term care, I have been at sites that have archaic computers that are shared by too many people. The system and thus productivity is slowed down. Often info isn't charted as people find it too slow. We still need to write info on paper and transfer it to the computer. So, yes, it is great to share/ have access that is the same no matter where you go, but the logistics need to be there, too. |
| records and photocopying kAnG Posted: 2009-03-10 08:44:14 Yup! I was charged $65 for a "photocopying fee". I asked them to just burn it to a disk that I could provide but they didn't like that too much! |
| photocopying fee KMac Posted: 2009-03-10 08:34:01 I had a similar experience when switching doctors last year. Only, my understanding is the record belongs to you but there is a cost to "transferring" the record, in my case it was a photocopying charge of $120!!! |
| Paying for your own health records! torontoONT Posted: 2009-03-10 08:20:25 Hi everyone: maybe some of you (Ontario residents) know this. My doctor is retiring and I found a new doctor in Toronto. That's the good news. The interesting news is that since my doctor "owns" my medical records for 10 years, there is an admin fee to copy and send records to the new physician. The charge is $35.00 for the first 5 pages and $1.50/page over that amount. The incumbent doctor won't release the file until the fee is paid. Has anyone else encountered this? Just curious. |
| Digitize medical records for access by multiple doctors Mike Smith Posted: 2009-02-27 20:45:09 This seems like a no brainer so why don't we get started? One of the big killers in electronic record conversion is converting all the old scribbles and miscellaneous notes laying around in folders in doctors offices. I would not attempt to digitize all this stuff because the person may be cured or it may no longer be relevant. It would seem that the most important stuff is the current medications the patient is taking and the most recent lab test results. Plus anything at the top of the pile that the current doctor thinks is relevant. That is the killer part. The next part is getting the new stuff into the system and that should be much easier. It would mean that every doctor has a link in his/her office to a central site for each patient that is updated directly by the doctor or if the doctor already has computerized records in his/her office then the system would automatically update the central site. This should not be done by the government otherwise it will end up like the gun registry and it will be useless. This must be farmed out to competent third parties who will bid for the work and be required to meet due dates and budget limits. Mike Smith |
| Time and Money Alex Favella Posted: 2009-02-26 14:20:35 There aren't enough doctors to start with, so many of us have to go to walk in clinics, and as a consquence your medical records can be found across several different practitioners and not in a single place. This fact alone leads to duplication and error. I know, I've lived it. I would be happy for the federal government to charge me a one time special tax to fund this digitalization so my records can be accessible by whichever practitioner I go to anywhere in Canada or aborad if I'm travelling. I've easily spent 10 times the amount in the last year and the "time" I've spent running around and waiting for all these appointments is worth much more to me than this special tax. Just imagine all the work hours that could be saved. Productivity in Canada would go up overnight for all of us, patients and practitioners alike. And as far as privacy, I really don't care much about that when my body is giving me something else to worry about; just keep the pharmaceutical and insurance companies out of it; restrict access to practitioners working on your file. |
| Start at the top eurobob Posted: 2009-02-25 22:24:26 Creating an EHR is a huge initiative and a necessary one given the often stated benefits. However, due to the many jurisdictions that control pieces of the healthcare pie in this country, obtaining agreement and setting a common objective is most often a very difficult task. Healthcare is funded, administered, and delivered at a provincial level. That means that there are 13 governments, setting 13 different health strategies, trying to develop 13 provincial EHRs, etc, etc. Sure, Canada Health Infoway has a pan-Canadian mandate to develop an interoperable solution but it has to deal with 13 jurisdiction, each of which may be comprised of separate regions, all of which are at different stages of development with respect to an EHR and may have different priorities. You get the point - this is not going to be quick and easy. Ideally, Canadians will realize that healthcare is too important, too big, and too expensive to be managed by each province. It's a concept that was put in place in 1867 and is simply no longer relevant. We need one government body to manage health care for the whole country. That way we can have one health strategy, one administration, one funding body, and one comprehensive health IT infrastructure. And while we're at it, let's take it out of the hands of politicians and into the care of an organization that has more than a 4 year outlook and can set policy that will ensure a sustainable system for future generations. |
| necessary but big bucks realist Posted: 2009-02-25 15:16:19 Digitalization of health records, EMRs, sharing of info between providers and institutions is all very well. Unfortunately, it is likely to be quite a money pit. Even though it is a necessary step to move Canadian health care into the modern era, the upfront costs and ongoing maintenance will add significant cost to the system...and yes, i can hear you saying "we can't afford NOT to do it"...but the reality is it is going to cost big bucks...upfront big bucks. Privacy is an issue and protecting individuals' medical information is costly...but the Gen Ys and the iGeneration seem much less concerned about privacy. Perhaps we are 20 years away from full acceptance of such programs. For evidence of the cost and the issues over obsolescence...just look at the UK experience. |
| No Question Paul Cosgrove Posted: 2009-02-25 13:23:33 Of course the records should be digital. 10 Billion dollars = DO IT. It is a great investment in the long run. It should be publicly funded yes as it will benefit all Canadians. Get it done. |
| So many in agreement - what's the holdup? anastasia Posted: 2009-02-25 07:16:51 Just about everyone who is writing in seems to be on the same page: we need to digitize our health records, we need to make the accessible not only to other health professionals but to ourselves, we need to ensure interoperability; not too many have brought up the privacy issue, which is what is cited so often as one of the barriers to digitizing and storing our health care records. I assume that privacy can be maintained as it is in other government areas and think we should move on. So why is everything happening so slowly? We are in the digital age and we are a highly sophisticated country when it comes to information and communications technologies. This is crazy. If there is one area that should be a priority for going on line it is health care. |
| Avoiding the software problems DevTech Posted: 2009-02-24 02:06:20 Any publlic money spent on automating the Canadian medical profession should require that all software produced be in the Public Domain - i.e. OSS - Open Source Software. This will help to prevent mistakes, provide many eyeballs to give oversight and create an interoperable ecosystem that could flourish and give Canada a state of the art system. And considering the importance of health care, it is shameful how unfamiliar Doctors and other professionals are with current technology. With that lack of experince by Canadian health car professionals, it is vital to go with a public domain based system in order to avoid the lack of interoperability and cost overruns that proprietary systems will produce. |
| THE DIGITAL FUTURE IS HERE AND NOW! chas nelson Posted: 2009-02-24 00:03:19 In industry 30/45 years ago most programs were in house designed , the user had to be rigorously trained to use them properly and the usable output was better than before but very stiff ie could not adopt to changing needs.Industry sped ahead using Digital products. Today there are generally a multitude of programs which all handle the similar inter related aspects and requirements of a business that can be adapted to any "new" company in a manner that serves that company best , requires limited training for basic computer knowledgable users and is adaptable to changing need. Industry could not profitabely exist today without DIGITALIZATION. In fact for $150 a modern Simplex type accounting program can be purchased and self adapted for a smaller company that will serve the company well, until it is a multi million dollar company! It truly fits a one or 2 man operation until it grows 20 times larger. In fact with little formal training people like myself have done this for 20 years and could not have made good money without DIGITALIZATION. The same approach and relatively simple programs exist for individual and multi doctor offices and for small and larger hospitals. The only requirement of user is enough personal or purchased expertise to get the right starter system and enough personal expertise to learn how to use. At the doctor's office there will be enough savings generated to justify the system solely by their personal time saving in inputting information , writing prescriptions and permitting easy analysis of patient data to plan treatment. Hospitals will find similar $ justification. The biggest hindrance in the past has been the fear of potential users that this "new" approach is not as good as some say; tens of thousands USER doctors and hospitals stand ready to disagree. The DIGITAL future is not far away; it is right here and ready for use. As old FDR said " The only fear we have is fear itself".. Every doctor, office, hospital, clinic etc will digitalize or die within the next 2 years. It is inevitable that some will die but most will be swept along and enjoy the benefits. Drawing comparisons between industrial material managent systems and and digialized medical data, huge time and dollar savings and efficiencies may expect to be created which will drive the system to generate unthoughtof future improvements in medical care and costs. Or so I believe based on my 40 years in business using digitalized applications. chas |
| doctors can be wrong williamashley Posted: 2009-02-23 19:50:26 Should creating electronic health records for all Canadians be a public funding priority? Sure, but not for billions, that is a joke. How many hospitals have a computer and an internet connection? How much do some servers cost? Not billions. All that is needed is a simple database program installed on hospital computers and central servers like the CPIC. It SHOULD NOT cost billions that is a raping of tax payer dollars. 30 million files may sound like a lot but it isn't if 10% of them contain next to nothing. if each person had one MB of data (a lot for a text file) that would equal 30000 GB. That may seem like a lot but that is only 30 TB, and get this http://www.itwire.com/content/view/8350/532/ by 2010 a 30 TB drive by seagate is unveiled, that would mean 1 MB for every single canadian on 1 harddrive.
2) What is preventing us from getting these systems in place faster? People trying to make more money or ineffective people - likely favors for companies and people. Doing work that takes longer. Get me a skilled programmer or a few, and this system could be in place within a week if every hospital had one person to get in touch with to install the software on the computer. The data is the only real delay.
The other important point is that, doctors can be wrong, Medical Records mean a whole lot, they just aren't for your medical health and well being they are used in a lot of other situations, and any fault, be it insurance, or court, or work they can be used against you, even if the doctor misdiagnosed. |
| work with ehealth daily Karla Posted: 2009-02-23 18:40:21 I believe in electronic records; I administer a small system in a small mental health program in a small hospital. The provider that was chosen (by a committee of managers) does not understand clinical records and has designed a very efficient system for capturing data needed by managers and funders. As a sometime programmer and senior psychotherapist, I could suggest a lot of re-design. However, the provider has our money and there is no incentive to meet our actual needs. I think inter-operability stnadards are a good idea, but I think that if we want an efficient system, we need to make sure programmers spend time in the ERs, ORs, health units, Dr's offices etc. etc. so that the product really reflects the way health care is best delivered - not just an awkward data collection. As bulky and full of difficulties as our current hard copy records are, they evolved with purposes that cover everything from information transfer, medico-legal needs to care plans and clinical evaluaitons to data required to impress the funders. All of the purposes of the old system needs to be re-created and enhanced with the new system(s). (Kind of a baby/bathwater problem I'm having) This is just one example of real life with e-records in the real world. |
| Forbid drug companies from access to digital records beerden Posted: 2009-02-23 13:39:16 It's about time to digitize all Canadian medical records, however, as the medical billing system in Canada is already controlled by drug companies, it too must be restructured. Presently, in our public healthcare system, a doctor is paid by the government, but only if they submit billing invoices that show they prescribed medication and treatments dictated by drug companies. This is a conflict of interest that most people are unaware of. If we digitize our medial records, we must forbid drug companies access, and only after we've eliminated drug companies from the influence of the billing system. |
| I like Jason's answer jenniferj9 Posted: 2009-02-23 12:32:33 @11:58 today and I want to contribute to this effort to create digital records personally - how do I apply for the job? |
| Digital and online Jason Posted: 2009-02-23 11:58:05 Not only is it essential that all records be made digital for fast, cross-hospital access, but patients should have access to their own records online. Patients should be able to log on and see essential items like their immunization shots, appointment records, etc. This move to electronic record keeping should indeed be a priority. While this would create an added challenge, it would be ideal to have some level of standardization across provinces. This would make health care more consistent across the country while also allowing for added efficiency in terms of system design. |
| Going digital Ghislaine Posted: 2009-02-23 11:11:30 Creating electronic health records for all Canadians definitely should be a public funding priority. There should be connectivity not only between doctors, pharmacies and labs but also between all provinces and territories including Quebec who forever likes to be excluded. That way, no matter where you are in the country, your medical history would follow you. Furthermore, the system should be like Revenue Canada's, where the individual concerned can also access his own file and be able to see test results for himself. That in itself would save time and money. I can only speak for myself, but here in Alberta, when I get any kind of testing done, I must make another appointment to get the results. That often means waiting another 6 weeks. If I don't do that, I will never hear anything further. You are called only if something is not normal. That means that someone has to look at the results, and when you don't get any feedback, you're never sure that your results have been looked at at all. If one had access to one's own file, one could then decide if a follow-up appointment is necessary to discuss any result that is not understood. |
| Interoperability standards -- could that be the answer? Ernest A. James Posted: 2009-02-23 11:06:20 "Data standards" is one obstacle to the acceptance of e-Health in Canada. Look at the computer industry -- you can quite easily surf the net today with any major operating system (Windows, Apple, Linux, UNIX, etc.) because they all follow the TCP/IP standard. As a primary care health provider, why would I install a Clinical Management System at the risk of the vendor disappearing in a few years; who's gonna be responsible for the cost of converting my data to another's proprietary system? Maybe it's time for Canada Health Infoway to flex some muscle and mandate some interoperability standards for any vendor interested in playing in the Canadian e-Health field. Ernest A. James President/CEO Regal Informatics Inc. |
| In support of EHRs Christine Posted: 2009-02-23 10:53:29 I would very much like to have access to electronic health records for my children and myself. Is there any pilot program in Ontario that we could participate in, in order to help make this happen. |
| e-records publicly funded? James J. Carty Posted: 2009-02-23 09:59:40 I do not understand why Canada has not had e-records in place for all Canadians years ago. The technology has been available for at least 15 years, maybe more and the benefits of reduced costs and improved patient care through real time access to all patient records resulting in better collaboration of healthcare teams and so on are so obvious, it is laughable that we are still studying it as opposed to doing it. I am pleased to see that some Hospitals are taking steps, however, without some form of national standardization, these may end up being steps that will need to be repeated. The issue is compatibility. If the UHN in Toronto does something on its own, laudable as that may be, can those records be accessed from another hospital in the same city or province, much less from another province. If I call an ambulance in many Canadian cities, I have no idea which hospital I will be taken to. Having e-records in one hospital is better than none, however, Unless they are accessible wherever I may roam, the value is diminished. In my opinion, this is something that should be in the forefront of Canada's current interest in infrastructure. It should be a national program, at least from a standards perspective, and it should be accomplished over the shortest time period possible, less than five years for example. As the baby boomers retire, they will become more mobile and they will need more care. Without national access to e-records, how will Canada cope. |
| Moving Forward Kurtis Posted: 2009-02-23 08:32:51 Without a doubt, moving our health care records into a more efficient digital form should be a priority for both the Federal and Provincial governments. Health care is the sacred, untouchable ideal of Canada, and while this is a noble sentiment, too often it means having to suffer the staus quo. I realize politicians and health care professionals are doing what they think is best for Canada, but we the public are often forced to see bureaucratic hurdles get in the way of proper care, (and sometimes even common sense). The digitizing of Canada's health care records will not solve all health care problems, but it is an obvious enough step forward that if we cannot get this done, there are serious questions as to how we will solve other, even more pressing issues. |
