Ontario’s health-care institutions have yet to tap into the $1.1 billion of federal and provincial funding given to Canada Health Infoway to create a nationwide e-health record, according to Ontario’s privacy commissioner.
Cavoukian made the comment to health-care executives attending a roundtable on getting the most out of IT investments in health care. Cavoukian, said she has had to wait 18 hours for surgery and was at risk of having a stroke because one hospital forgot to send a CAT scan to the other hospital where she was having the procedure done. The absence of interoperability between Toronto hospitals’ systems is a big problem, she said.
“In remote areas all of the hospitals are talking to each other,” said Cavoukian. “In Toronto we can’t get (systems) to talk to each other. (Hospitals) should tap into this federal pot. It’s essential that we work on this.”
Gwen Yacht, director of privacy and health information at Baycrest Centre for Geriatric Care in Toronto, however, said people would rather see the money invested elsewhere. “Families know we are using funds to build e-health records that they would rather see in nursing,” said Yacht. “We have to believe that e-health records will make it easier for staff. I don’t think we can wait for proof of positive financial return on investment. We’ve made decisions knowing that it couldn’t financially pay for itself.”
But Dan Coughlan, chief financial officer of West Park Healthcare Centre, said, without a tangible return it’s difficult for health-care institutions to justify multi-million dollar investments. “How can we support decisions to invest millions and millions of dollars when there are other demands to keep current systems going forward,” said Coughlan, adding that technologies aren’t advancing as fast in the Canadian market. “This is where it becomes an art as well as a science. Where do you find the measurable savings — the things that have a hard return on them?”
Cavoukian said there’s no question there’s an expenditure at the front end that probably will not be recognized in terms of cost benefit for some time. “People aren’t tapping into (Canada Health Infoway) funds,” she said. “I recently talked to the CEO of Infoway who said Canada Health Infoway will match dollar for dollar hospitals’ funding in this area.”
The reason why Ontario hospitals aren’t doing that is due, in part, to an “advertising problem” by government agencies, said Thomas Goldthorpe , information systems director for research at University Health Network (UHN). “It’s not just government agencies but it’s making sure they work in conjunction with agencies that are disease specific,” said Goldthorpe. “Those agencies aren’t going to build a complete health record but pieces that work with it.”
Glen Geiger, director of clinical information systems and informatics at Sunnybrook and Women’s College Health Sciences Centre in Toronto said researchers have to get together and resolve several problems including privacy and data collection inefficiency issues. “They have priorities in same ways I do but unless they get together cooperatively, we can’t get anywhere,” said Geiger. “Everybody’s doing their own things. We’re going to complete these systems and we’re going to have to do it again.”
Cavoukian said, theoretically, that’s what health infoway is mandated to do across the country. “It’s a mammoth task,” she added. “In defense of specific databases they’re doing research in their areas and it’s invaluable. They have too much invested to give it up until you build the new database.”
Geiger, however, said there are still a lot of political roadblocks that stand in the way from making a unified health care system a reality. If IT, for example, represents five per cent of a hospital’s overall budget, the provincial government is cutting that back to two per cent in five years time, said Geiger. “Getting over the political hurdles seems to be difficult. They know we’re inefficient,” he said, adding UHN and Sunnybrook are working on a joint request for proposal for a blood bank system.
Inefficiencies in the paper-based system could be resolved by investing in smart systems, said West Park’s Coughlan. These include storage space and sharing of information. Roman Olarnyk, chief information officer for Ontario crown corporation Smart Systems for Health Agency (SSHA), which was set up to provide the essential infrastructure for Ontario’s health-care system, said health care is the second most information-driven industry next to energy. “Smart systems was developed as response to those pressures that each health care institution is looking for in terms of helping to transform themselves through the sharing of information.”
Goldthorpe said e-health records contain a lot more than pure patient information. “Records provide a lot of detail which can be used for helping to find out something about a disease that can only be sought out in a large population,” said Goldthorpe.
While smart systems are helping to improve structures and processes, they aren’t making access to information any easier, said Chris Ferrao, manager of financial planning at William Osler Health Centre, which has sites located in Etobicoke, Brampton and Georgetown. “We have to start a group and give a timeline,” said Ferrao. “We have a lot of consultants available and we’ve been studying this for a long time.”
However, Geiger said there are a few barriers preventing this from happening. These include resource allocation and finding the funding from institutions to assemble groups. “These pieces go together like a tinker toy,” said Geiger. “Most hospitals have done enough work with pieces. Assembly of this stuff isn’t that big of an obstacle.”