Ontario hospitals struggle with electronic patient records

TORONTO — Ontario’s hospitals are all too small to successfully implement an electronic patient records system, a health-care expert told his peers Monday.

This week more than 7,000 doctors, nurses and other health care professionals are gathering at “Touching Technology,” the Ontario Hospital Association’s 2001 conference and exhibition. The event covers everything from leadership in the nursing profession to clinical engineering, but many of the guest speakers and panel discussions are exploring the ways information technology can improve the province’s health-care system.

But in a session that took a critical look at the evolution of electronic healthcare information integration, HealthLink Clinical Data Network CEO Dr. Michael Guerriere told delegates the industry is ill-prepared to automate patient record-keeping. Some hospitals have made headway, he acknowledged, but they don’t usually link the electronic patient records with other hospitals, or negate the need to look up paper-based data in a file cabinet somewhere.

Guerriere said shared services and central data repositories offer some solutions to hospitals, but he said Web-enabled front end integration will be necessary to make the system really work properly. He used the example of the process he recently used to purchase a personal computer to demonstrate. He started out with Yahoo! to look up computer manufacturers, where he was directed to Dell Canada’s Web site. He followed Dell’s online ordering system, then tracked the shipment of his order through Purolator’s portal.

“Imagine ordering a CT scan and knowing where it was in that process,” he said, noting that all three sites deal with different data formats but have standard ways of displaying them in a browser. “At no point are they querying each other. I’m just querying each one and they’re pointing to different databases.”

This model could work for health-care providers, he added, providing they came up with the appropriate secure access channels, identification management tools and interfaces.

Overall, Guerriere said the health-care system compares poorly with other industries in the way it responds to its customers. He used banks and airlines to show the contrast with the ways hospitals conduct their regular work. “In a bank, you’d have a paper ledger only available at one branch,” he joked, “You’d get an incorrect balance because the teller’s handwriting was illegible.”

Irene Podolak, a nurse and partner with Deloitte & Touche, said it’s not that simple. Podolak has been part of a D & T team that has been helping gather data for a provincial effort called Smart Systems for Health. The project is trying to establish standards for the integration of health-care information to providers and consumers launched in the spring. Though the committee has tried to look for existing standards in other industries, it had to build most of its organizing framework from scratch.

“The banking industry is no the same as the health industry,” she said. “There’s just a couple dozen transactions that you would use with your banking system, but there are hundreds of types of transactions that occur at various stages of the health care system.”

Podolak said the efforts of Smart Systems for Health are challenged by a lack of buy-in to the standard development process. That’s because the benefits of standards development go to the system as a whole, rather than an individual health care provider or vendor, she said.

The health-care system has not had a good history of adapting quickly to technological change. It was only after much lobbying, for example, that the industry was given a one-year grace period before adopting Canada’s Personal Information and Electronic Documents Act (formerly Bill C-6). Both Guerriere and Podolak said health care providers have to start catching up now.

“If we don’t do something to expedite it, we’re never going to have the kind of standards we want,” she said, adding they must be simple and flexible. “There’ too much confusion over what standards are these days.”

Guerriere added that the system is largely a victim of its own success. The more progress health-care providers make in helping people survive disease, the more expensive it becomes to maintain their treatment. With a gradual deficit the number of nurses entering the field and rising health care spending, technology will have a more important role to play. “Patients are losing patience with us because service levels are not consistent with what they’re experiencing in other industries due to improvements in IT,” he said.

The OHA’s conference and exhibition continues through Wednesday.

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