The second annual Branham Group Inc. e-health in Canada survey has found that the more things change, the more some things stay the same.
The national survey of hospitals, primary and continuing care, released Tuesday, indicates that e-health initiatives across the country have moved from the technology acquisition stage to the implementation phase.
“What we found this year is a lot of their emphasis is on implementing the functionality in the software they had purchased,” said Michael Martineau, project lead for the study.
That doesn’t mean everything’s done yet, though, he said. “In many cases people are just rolling out pilot programs so use is probably a little lower than deployment.”
Most of the deployments are in the finance and administration departments, as well as in areas such as pharmacy and labs. Departments such as emergency care and computerized physician order entry have a much lower degree of deployment, he said.
But CIOs are still not getting through to vendors as to what they need to successfully undertake e-health initiatives, it seems.
When asked what advice CIOs would offer vendors wanting to sell their products and services, CIOs said what they have been saying for years: vendors need to better understand them as customers.
“Not all hospitals and health-care customers are the same – they differ regionally, provincially, and urban versus rural,” he said.
CIOs also want U.S. vendors to get a grip on the fact that health care in Canada is publicly funded and therefore follows a public procurement model.
“End of quarter deals don’t mean much to them,” said Martineau.
Vendors must also offer products built on standards that make it possible for systems to work together.
“CIOs are saying we can’t buy standalones,” he said. “We increasingly have to create enterprise systems that have integrated environments and we need the software to work with each other. Several CIOs made it clear they would be using these standards in their RFPs, so you need to understand where the standards are going.
Canada Health Infoway is trying to ease that process by bringing standards bodies together under a single umbrella, he said.
Health-care CIOs also want vendors that are in it for the long haul, and partners who play nice with others, he added.
“They are looking to the vendor community to start to co-operate more,” he said. “They are starting to have requirements that transcend what any one vendor can do and they don’t want to do the integration themselves, they want vendors to figure out how to solve the business problems, and you guys have to work together more to bring solutions to the table that solve the business problem.”
On top of that, CIOs want vendors that are smart enough to use their previous experience with other e-health care projects to help them build their own business cases.
“There’s a feeling that as vendors you have worked with other hospitals and organizations that you could bring to bear to help to make the business case, and if you could do that it would be very much appreciated,” said Martineau.
Those who don’t start meeting CIO expectations can expect to find themselves shut out of the game entirely, he said, predicting vendor consolidation and an increasing number of aggregations of health care organizations.
“You see in other industries as they start to mature they pick a few key vendors,” he said. “In Newfoundland and Labrador, for example, they recently reduced the number of health authorities they have. So the result is we’re going to see fewer data centres, fewer networks, and fewer vendors, and we’re going to see bigger projects.”
The two main areas of opportunity at the moment are wireless and voice over IP. Most health-care organizations surveyed permit the use of wireless devices and are deploying wireless infrastructures to support point-of-care applications. Some 75 per cent indicated they are planning to or already have implemented voice over IP. Open source, however, is of “zero interest” on the clinical side, the survey found.
Diane Salois-Swallow, joint CIO at York Central Hospital and Southlake Regional Centre (and also a registered nurse), said her organization’s experience with e-health has enabled health-care providers to save time and deliver superior services. Salois-Swallow said the hospitals developed a clinical portal that provides a wide range of patient information, such as charts, lab results and X-rays. Doctors, 90 per cent of whom now use it, like it because it’s easy to use and provides a single point of access to patient information, she said.
“We have achieved a lot of benefit that’s hard to quantify,” she said. “Radiologists are telling us they’re able to better diagnose with PACS images.”
But while doctors working in hospital settings might be seeing the benefit of using electronic health records, family physicians are slower to embrace the idea, said Dennis Giokas, Canada Health Infoway’s chief technology officer.
“Despite the growing enthusiasm, we do have a long way to go,” he said. “Only about 20 per cent of physicians are using an e-HR today. The GPs are critical because they provide the data that will be used in the e-HR.”
The other piece of the e-HR puzzle, though, is investment, said Ron Dunn, vice-chair of the Canadian Healthcare Information Technology Trade Association.
“Investment in e-health has increased in recent years, but it’s still well below other industries,” he said. “One of our goals is to find and seek ways to increase responsible spending on e-health initiatives. With an aging population, finding new and innovative ways of delivering health care services is critical to maintaining Canada’s world class system, and because it generates such future benefits, it has to be seen as an investment, not as a cost-elimination exercise.”