Electronic health records: Condition critical

TORONTO — The next time nurses go on strike, it might not be for the traditional demands of better pay or improved working conditions but the lack of an electronic health record, panelists told a health-care symposium at George Brown College this week.

An electronic information system might

not make a big dent in the yearly loss of 3,000 nurses in Ontario, after retirements, death and graduates are figured in, but it will contribute significantly to improving the work environment by providing access to the timely information nurses need, said Mary Ferguson-Pare, vice-president of professional affairs and chief nurse executive at Toronto’s University Health Network.

“”I’ve been in this work for more than three decades, and dear God, it’s taking us a long time to get something done about this,”” she said. “”I do get incredibly discouraged because I can’t believe we’re not moving forward more quickly.””

Ferguson-Pare, who served as a member of the clinical advisory team for the Ontario Ministry of Health during last year’s SARS outbreak, said the need for an electronic health record (EHR) system became evident during the SARS situation.

“”The health information systems issue in Canada is so grave that we truly managed the public health care crisis in Toronto with Post-it notes and boxes of paper,”” she said. “”We don’t have the capacity for information to be shared easily or readily.””

At the same time, she added, “”We certainly know we continue to have an infectious disease environment; it won’t go away, it will reoccur.””

But improving the working environment for nurses, as compelling as that might be, is not the only reason Canada should move forward on an EHR, said Mariana Catz, a former chief advisor on e-health for Health Canada and a technical officer for the World Health Organization.

According to Catz, studies from the U.S. show more people die from medical errors every year than they do from highway accidents, breast cancer or AIDS. Eighty per cent of nurses calculate doses incorrectly 10 per cent of the time, and 40 per cent make mistakes more than 30 per cent of the time.

“”IT plays a critical role in reducing those errors . . . (but) you can’t just plunk the technology down and hope the problem is solved,”” she said.

Dr. Matthew Morgan, director of medical informatics at Misys Healthcare, noted that statistically, patients in the U.S. are more at risk of dying from medical errors – 4,500 times more at risk, to be precise – than they are from accidental gun deaths.

There are 700,000 doctors in the U.S. and 60,000 accidental deaths by physician, compared to 80 million gun owners and 1,500 accidental gun deaths.

“”It’s because we’re asking our clinicians to work in an environment without the right information management tools. We’re asking them to rely on memory and frankly, that’s crazy,”” he said.

Based on an extrapolation from a U.S. study on the cost savings that could be realized by implementing an EHR, Morgan estimated that if Canada’s 747 hospitals could save more than $1.2 billion a year. If our 30,000-plus physicians e-prescribed, we would save $236 million over three years, he said.

Catz said the health-care industry could learn a lot from the airline industry, which she called “”obsessive”” in documenting not only its failures but its near misses. In health care, she noted, the medical error death statistics don’t tell us about all the times someone nearly died.

Another advantage to creating an electronic record system, said panelist Fran Richardson, registrar and chief administrative officer at the College of Dental Hygienists of Ontario, is that it would allow health care practitioners from outside the traditional sphere of doctors and nurses – such as dentists and optometrists – to have a better, more complete picture of a patient. That’s essential, especially in situations where a dentist or hygienist, for example, goes into a long-term care home to treat a patient, she explained. If a dietician has recommended a certain diet, but the patient can’t eat the food because their teeth are so broken down, that information needs to be available.

“”You probably think you don’t need to tell your dentist about your health history. Wrong. You do, especially around prophylactic antibiotics, so we need to be able to integrate those forms,”” she said.

But an EHR, useful as it may be, does not come without headaches of its own, observed Richard Shekter, a medical malpractice lawyer with Shekter Dychtenberg.

“”The real issue is while the justification for enhancing patient care (through EHR) is unassailable, the means by which you have to work to protect yourself and the rights of your patients gets immeasurably complicated,”” he said.

That’s because health-care organizations, like the private sector, are now governed by the federal Personal Information Protection and Electronic Documents Act (PIPEDA), he said, a piece of legislation which was never designed to meet the needs of the medical community.

And although students in the health care sciences might think confidentiality is the hallmark of the health care system, he said, “”I’m here to tell you that is largely a myth.

“”I can tell you as a lawyer practising in the health field every day I am reading the health records of 10-20 patients I’ve never met. I get automatic access to the health records of the doctor who may or may not have seen thousands of patients over a 10-15 year period.””

For health sciences students with an IT bent, panelists said, the future offers many opportunities, more so than for those whose background is solely IT.

“”The big difference is health informatics professionals come to IT with domain expertise, and IT professionals who come from outside health care don’t have that expertise,”” said Morgan. “”Often when you try to take principles from outside into health care they don’t work because health care is so complicated.

“”One of the biggest problems we have is we don’t pay enough attention to project management and change management, so 70 per cent of IT implementations in health care fail,”” added Morgan. “”With health care professionals in informatics, there is a much greater chance of success.””

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