E-health strategist: Stop whining about funding problems

Health care IT professionals frustrated about the lack of funding to implement electronic health records and other major IT projects should just get on with their jobs and stop whining, Ontario’s e-health strategist told the Ontario Hospital Association’s 2005 conference.

“Our user fees and the business challenges we face are really the priorities,” said Roger Girard. “The priority is not about IT and it’s not about technology – it’s about the right business transformation agenda and how we can support it and how e-health can act as an enabler of that. There are many different ways of doing that.”

Girard, who spoke after a panel of health care executives discussed the most pressing issues they see in developing the infrastructure required to implement a province-side electronic health record, said CIOs need to stop saying IT has to compete with other health care investments for money.

“We have to avoid seeing e-health investment versus hiring as a tradeoff,” he said. “I hear a lot of times the CIOs complaining, whining about ‘we have to compete against medical technology, we have to compete against nurses.’

“This is not about e-health and it isn’t a competition. We need to stop using that as an excuse for not doing things, and there are a lot of people in Ontario that are not using it as an excuse and are just getting on and doing it.”

“Don’t wait for the government,” he advised.

But if the hospitals are “on the hook” for IT, said Hy Eliasoph, CEO of Ontario’s Central Local Health Integration Network (LHIN), what does that say about the province’s commitment to the fact that IT is an integral part of health care delivery?

“It’s time to change our focus,” he said. “We’re actually not in the health care business, guys, we’re in the information management business, and the sooner we can start thinking about that, the sooner we can start delivering better health care.”

Gaston Roy, CIO of the Sudbury Regional Hospital, which is part of LHIN 13, echoed that concern. Roy, whose hospital serves a population of 650,000 people spread out over 40 per cent of the land mass of Ontario, says LHINs 13 and 14 have worked together to develop a full information communications technology blueprint.

“We are ready to move ahead with the one record, one patient approach,” he said.  “The difficulty is the funding – you can find funding to develop and try systems, but when it comes time to actually building a one record one patient approach, it’s very difficult to find funding.”

Sudbury’s solution has been to share services with other health care providers in the region to the extent possible.

“It’s really an agreement on how we’re going to share costs and how we’re going to bill the system,” he said.

The question for many health care executives is which level of government should be responsible for investing in IT, said Tony Dagnone, CEO of the London Health Sciences Centre.

“The feds need to be there,” he said. “They are the ones that have set targets and they have left expectations for all Canadians to have an E-HR by 2009 or 2010.”

Dagnone argued that just as the federal government has provided the provinces with funds to invest heavily in diagnostic equipment, it should do the same for IT.

He called investing in health care IT the equivalent of “digital nation-building.”

“We can’t improve patient safety without doing a better job in bringing all that information together,” he said. “They’ve already started with Canada Health Infoway but I think we have to convince them it ought to be more a lot than that.”

But the $1 billion the federal government has invested in CHI over 10 years is a mere drop in the bucket, said Michael Carter, a professor in the mechanical engineering department at the University of Toronto and director of the health care resource modelling lab.

“Our health care budget is over $100 million a year so that’s .1 per cent annually,” he said. “Banks are (investing) 14 per cent a year (of their IT budgets) just so we can find out how much we have in our bank account. I think one of the issues about IT is $1 billion is not even close to solving the problem.”

Girard, however, said despite the skepticism, Ontario had made quite a few advances in its e-health strategy.

For example, he noted, thanks to SARS, Ontario now has a public health strategy that is the envy of all other provinces.

“The way we managed the crisis then was through yellow stickies,” he said. “Today there’s a single system in place in Ontario that tracks communicable diseases across the entire province. It’s the only one in Canada, and no one thought it would be possible three years ago.”

Other advances include the fact that all hospitals except for one in James Bay are hooked up to the Smart Systems for Health Agency network and there is an e-health record for 300,000 children in the province. As well, Ontario is a leader in telemedicine, he said. There were 25,000 telemedicine “events” last year, he added.

“There are three networks and they’re coming together very shortly and they will be totally interoperable. This is a story of exponential growth.”

The Ontario Lab Information Systems project, which will provide doctors with electronic lab results, is also expected to go live next spring.

As well, despite the apparent chaos in terms of governance, the e-health council provides overall leadership to all the other councils.

“I would argue the leadership has to come from you,” he said. “This isn’t going to come from on high.”

The OHA conference wraps up Wednesday.

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