Many Ontario physicians still allergic to electronic records

E-health in Ontario has certainly made great strides from where it was just a few years ago.

But industry experts are not ready to celebrate yet.

They note that despite undeniable advances, resistance to digitized patient information still remains quite high among the province’s healthcare practitioners.

Such resistance is one of the problems Smart Systems for Health Agency (SSHA) has had to overcome in its quest to deploy a province-wide e-health infrastructure.

This Agency of the Ontario Ministry of Health is now five years into its mandate.

So far SSHA has connected more than 5,000 locations to its ONE Network that enables healthcare providers to securely store, access and share patient data online, and collaborate with one another.

However, many physicians operating in individual offices remain hesitant to commit their records to the system.

On its part, the Agency has had its own issues.

It has been criticized for being behind schedule and being secretive, and brought in a new CEO to head its turnaround strategy.

Despite the difficulties they encounter, organizations such as the SSHA have a pivotal role to play as they herald the wave of the future, says Ross Armstrong, technology analyst at Info-Tech Research Group Inc. in London, Ont.

Online collaboration and sharing patient records and lab results delivers extraordinary benefits, says Armstrong, who has extensively researched electronic health systems in North America.

“If you can transmit x-ray images or lab results from one location to another that saves the patient from going through the same procedure again when he or she transfers to a different hospital.”

And yet, though the benefits are evident, challenges to adoption remain, the analyst said.

He believes use of the technology might take off if hospitals start offering patients free access to their medical records.

Workplace culture and the cost of migrating existing data to digital format also impede widespread adoption, said Armstrong.

An SSHA executive agrees.

About 1,500 physicians or just eight per cent of the province’s doctors are connected to the Agency’s network, noted Paul Kilbertus, director of communications at SSHA.

He says technology issues and their perceived impact on business processes are holding back most doctors and smaller organizations from taking the plunge.
“The products and services are free but individual technical issues can be a considerable problem.”

For instance, he said, some health clinics may be tied to legacy systems that present compatibility problems or may have limited resources that prevent them from establishing and maintaining interfaces to the SSHA network.

Physicians are also considering whether moving over their records to the network makes good business sense, Kilbertus said.

“For doctors used to communicating by phone and transmitting medical records by fax, the question is what value [exists] in switching to digital.”

Armstrong said some clinics are likely worried about the time and resources that would have to be expended in transferring hard copy patient files on to digital media and training staff in the use of new devices and business practices.

“This would mean a considerable downtime. Most clinics are too busy already and any minute away from the practice means money going out.”

One doctor, who asked not to be identified, said he is also concerned about immediate availability of records. “My file folders are available all the time. How will I be able to access electronic files when the power is out in my office?”

Security and continuity of operation is a major preoccupation at SSHA, according to Mark D’Aoust, director of operations at the Agency’s facility in Markham, Ont.

The 5,000 square foot SSHA facility is within a 270,000 square foot data centre operated by Hewlett Packard.

The nearly windowless and expansive two-storey building, located in an industrial area north of Toronto, houses data used by the 13,500 healthcare workers who are registered for use of the Web-based services offered by SSHA.

The building is connected to two separate power grids to ensure continued power supply in the event that one of the grids fails, D’Aoust said during a recent tour of the facility.

Eight 3,750 horsepower diesel engines are on stand by as a further backup should both grids go down and a similar facility is located nearby as a backup site for the data centre. Servers are also hooked up to separate power supplies.

Access to SSHA areas and the Agency’s severs are controlled by redundant security features such as smart ID passes, keypad and biometric locks. Server racks are even partitioned so technicians can only access the areas they are authorized to work on.

Apart from ONE Network, other products offered by SSHA include:

  • ONE ID – a system that allows users to access SSHA services
  • ONE E-mail – a secure e-mail service
  • ONE Portal – a Web-portal development service for clients
  • ONE Support – a help desk service for users, and,
  • ONE Hosting – an SSHA computer equipment hosting service that enables clients to offer software applications to their users.

Within the next five years the Agency hopes to further extend its electronic health record (EHR) services across the province.

EHR data may include a patient’s past medical and hospital treatments, immunization and laboratory records as well as prescription drug and allergy profiles.

The SSHA is also upgrading the public health system for managing disease outbreak management to enable health care practitioners gain faster access to information that can help them assess the progress of an outbreak and determine possible countermeasures, said Kilbertus.

But Armstrong cautions outfits considering adoption of services similar to those offered by SSHA to pay attention to three issues:

Define data ownership – When registering with a network, determine who owns the data used, he says. In general, the creator of the data is considered its owner.

Ensure privacy laws are upheld – Protect your patients and yourself. Make sure the network addresses privacy issues properly. Check how privacy policies would apply if data is being transmitted across jurisdictions.

Research security and data recovery capability – Ensure the service provider can provide the security you need and will enable you to access data in the event of emergencies or disaster.

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