Missed connections: the adoption of information technology in Canadian healthcare.

Author:Protti, Denis
Position::COMMENTARY NO. 422
 
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Despite the ambitious efforts of Canadian governments to amass digitized health data there will not be any large-scale benefits until the information is shared between providers and institutions.

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THE STUDY IN BRIEF

Despite the ambitious efforts of the provincial and federal governments in Canada to implement Electronic Health Record (EHR) systems, the level of health information exchange across organizations and care settings in Canada is among the lowest in surveyed countries. Some survey findings revealed that in primary care only 12 percent of physicians are notified electronically of patients' interactions with hospitals or send and receive electronic referrals for specialist appointments. Fewer than three in ten primary care physicians have electronic access to clinical data about a patient who has been seen by a different health organization.

Certainly, progress has been made, namely in the development of the infrastructure to store and share health information, as well as some use of information technology in primary care, but the delivery of healthcare in Canada has yet to take full advantage of the major potential benefits.

The aims of EHR programs include reducing duplication of, and errors in, patient records; taking advantage of information and communications technology to improve patient outcomes--by delivering patient and medication data to where and when it is needed; and saving the time of patients and providers.

In Canada, there will not be any large-scale benefits from gathering masses of health data until the information is shared among providers and institutions, such as between a family physician and a hospital. Leadership is required to drive continuous change and quality improvement toward integrated care. To do so, appropriate incentives are also required. Providers and provider teams need to be held accountable for improvements to happen.

One key characteristic shared by many leading healthcare jurisdictions is the incentive to improve outcomes for patients at risk, in contrast to the fee-for-service reimbursement models that create incentives for higher treatment volumes. Leaders need to set goals and incentives for improved quality of outcomes and hold institutions and clinicians accountable for achieving those goals.

Canada's federal and provincial governments have made large efforts, often at great cost, to digitize patient health information. Using electronic health records (EHR) (1) can reduce errors in patient records, eliminate duplication of tests and procedures, and improve patient outcomes by delivering patient and medication data where and when it is needed, while saving the time of patients and providers.

There are many global EHR successes--and numerous expensive failures--to learn from. In Canada, the failures are well documented in numerous auditor general reports, both at the federal and provincial levels. This Commentary recognizes EHR's challenges and past shortcomings, yet expresses optimism that the many benefits achieved by others may be realized in Canada.

Progress has been made, namely in the development of infrastructure to store and share health information. There have also been successes in the use of information technology in primary care; however the delivery of healthcare in Canada has yet to take full advantage of EHR's potential.

Analyses of EHR programs worldwide show they can improve the quality of care and reduce patient risk, for example, by cutting prescribing errors and by providing and sharing information promptly, which are vital for people with complex conditions whose care is often provided by several different clinicians and organizations. (2) When properly implemented, EHRs also free up nurses' administrative time, allowing more opportunity for direct patient care. Furthermore, linking data from different organizations helps determine how well a patient has been treated in the course of an illness, whether treatments and services are having the impact desired and how they might be improved.

This Commentary looks at the progress that Canada's provinces have achieved, where they have faltered, and at the obstacles to the further development and expansion of EHRs. As well, it proposes ways to increase the likelihood that the public can reap the benefits associated with greater exchange of health information. While failures are well reported publicly, there are less well-documented relative successes. One potential measure would see governments and providers --perhaps as part of compensation negotiations--adopt a set of principles that emphasize the role and use of EHR systems in clinical practices, as well as formal commitments to open up primary care records to patients by fixed dates.

The Canadian healthcare sector faces serious challenges that have an impact on EHR. Fiscal consolidation is causing most provinces to reconsider their funding for electronic technology programs. And healthcare delivery is increasingly focusing on lower-cost locations--such as in homes and communities--with mobile technology helping overcome geographic issues. Furthermore, demographics and technological advances will put pressure on health system design and provider responses.

But bringing care closer to the patient, strengthening the linkages between outcomes and accountability and giving the patient a more active role, require interconnectivity, or the electronic exchange of health information. The level of health information exchange across organizations and care settings in Canada is among the lowest across surveyed countries (Health Council of Canada 2012, Accenture 2012). Some findings reveal that only 12 percent of primary care physicians are notified electronically of patients' interactions with hospitals or send and receive electronic referrals for specialist appointments. Fewer than three in 10 primary care physicians have electronic access to clinical data about a patient who has been seen by a different health organization (Accenture 2012).

In what follows, I discuss how healthcare systems in the United States and abroad have addressed some of these challenges. I place lessons from abroad into the Canadian context, where integrated care is difficult to achieve and there are few incentives for providers to maximize the benefits of EHRs.

Potential Benefits of EHRs

In principle, EHRs could serve a number of valuable purposes. (3) Patients generally wish to use their health information to get faster access, better care and reduce clinical practice errors, including redundant testing and diagnostic procedures. For providers, EHRs can inform clinical care, public health officials and biomedical researchers. It can also result in cost-effective care, as well as facilitate better communication among healthcare providers and with patients.

Examples of these benefits can be found in health regions with well-advanced EHR systems. In many parts of the United States, enhanced EHR has allowed for reduction in mortality rates, greater completeness of medical records and improved evidence-driven protocols for medical procedures (Box 1). Whether any of these benefits can be realized depends not only on the framework for the exchange of health-information technology but also on implementation details, such as who will lead change, how clinicians will be involved and what incentives will be included to encourage greater exchanges of information.

Electronic Health Globally

A number of organizations and individual researchers have documented at least part of the global EHR picture (Anderson 2006, Protti 2007, Schoen 2012, etc). (4) Unfortunately, there is no comprehensive picture of global EHR implementations. None cover all nations, while many deal only with a single sector (e.g., the use of health-information technology in primary care). That said,...

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