Thursday, 5 April 2012
Electronic Health Records - so much spent and so far from achieving the goal
Canada Health Infoway Canada Health Infoway has spent $1.6Billion since 2001 trying to build electronic health record infrastructure. Te previous blog speaks to some of the success in improving convenience with telehealth. Much of CHI spending has gone to support laboratory infomatics, radiology picture archieving systems (PACS), and a dribbling into electronic medical records. Admittedly standards have been set internationally on data infrastructure to facilitate communication between systems, however where are we? To read a rather scarthing report of Canada Health Infoway specifically the Office of the Auditor General report at 2009 OAG report Chapter 4
Major health care facilities have aligned behind a small cadre of electronic backbones that integrate hospital encounter data with financials. They are poor long term management tools for patients. Electronic medical record systems are better designed for repeated episodic care coordinated from a single office and were only available to 17% of people in 2009
Most provinces have stand alone pharmacy systems that track medication dispensing. Several attempts have been made for integrated public health information systems, that minimally interact with other health care systems. Laboratory data is aligned behind the lab providing the service and not the client to the whom the values are important. Same goes for radiology. Residential care information is almost non-existent and home care encounters are among the least electronically documented services.
Clearly lacking are the full system structures that take a holistic view of the patient/client, case manage their needs through multiple health care provider encounters – and most importantly where the information is accessible from multiple providers. No doubt care has improved, both in the doctor’s office on management of chronic diseases, and during acute episodic care. We are still several leaps from delivering on the vision of a truly functional electronic health record.
Canadians trail their international counterparts in electronification of health records – this in a supposedly universal care environment. Not surprising, tracking of finances has been a better driver of improved electronic health records than has the Canadian covenant on universal health care.
Professionals hide behind cloaks of confidentiality and other feeble excuses like the need for a pan-Canadian immunization register. Patients live in relative ignorance of the threat to their wellbeing that lack of interconnectivity imparts. Fundamental changes in how we do health can save huge costs, yet relatively little is being done to require change, caught up in legal debates and vaguely veiled ethical issues.
As for being your own keeper of your heath information – just try to pull together an integrated health record based on your interactions with the health system. Expect to pay for photocopying of “your” files, and deep resistance to releasing “your “ medical records to yourself rather than a health professional to whom you have entrusted your care. And don’t be surprised about the gaps in information, many records are irretrievable prior to electronification – and at some point data management becomes problematic and even electronic records are stored in cyberlimbo.
Until patients demand change, and demand that the providers of health care contribute your data in a fashion that you can control, expect slow and less than methodical progress on data integration. In the meantime, there are many radiologists that appreciate being able to access the publically funded PACS system from the comfort of their bedroom rather than having to visit the hospital. Pathology samples that are being sent across provinces in digital format for interpretation so local health systems can reduce costs. ECGs that are being read digitally from who knows where? Has this convenience improved the care that you receive? Unlikely.