Infoway chief offers check-up on EHR progress

Richard Alvarez has some explaining to do.

A study of 6,000 doctors from around the world released by the Commonwealth Fund last week said Canada lags behind on several aspects of patient care, including the use of electronic medical records. In Canada, only 23 per cent of doctors surveyed said they used them, compared with 98 per cent in the Netherlands and 89 per cent in the U.K.

That was a blow to Canada Health Infoway, which is charged with accelerating the development of electronic health record (EHR) solutions with compatible standards and communication technologies across Canada by the end of 2009. Infoway provides funding for a variety of projects related to electronic medical records (EMRs), which are usually owned and maintained by a single provider organization, and EHRs, which summarize clinical data from multiple provider organizations’ EMR systems.

Alvarez, Infoway’s chief executive since 2004, spoke to about their take on the Commonwealth Fund report. What did you make of the conclusion that Canada had fallen behind?

Richard Alvarez: Well, my reaction to the overall study was embarrassment and shame on Canada, that we would be so far behind the curve in areas that are absolutely crucial to Canadians which are basically things like chronic disease management, the sharing of discharge records for Canadians being discharged from hospitals, records being sent back to docs, or docs never receiving them or receiving them too late.

That was my initial reaction. My reflection on it, of course, was a lot of these countries got started 10 to 15 years ago at least, especially in the U.K. and Denmark and other places, certainly with their GP population and EMRs. Strangely a lot of them are now moving from the EMRs and to the EHRs, from the medical records to the health records. It’s indicative when you read the study, because one of things that didn’t show up so well even in the countries that have got a lot of technology in doctor’s offices is they’re having a tough time accessing the records outside their own offices, and they’re having a tough time accessing hospital records. That’s very interesting, because we didn’t start with the EMR. We started with the EHR.

ITB: Why was that?

RA: We started with that for good reason. One was because at the time when Canada started with EHRs there weren’t a proliferation of EMRs in doctors’ offices, which was really something that’s not typically none nationally but provincially, with provinces negotiating with their docs to get computers in. When we looked at our statistics as well, the system errors, the adverse effects occur in hospitals, in emergency departments. We wanted to make available at that front line, medication history, lab results and diagnostic imaging, which we are starting to do. And then as EMRs start to get to put into doc’s offices, they’ll be able to pull down this other information which is in many cases derived out of doctor’s offices, into today’s EMR systems.

ITB: Infoway’s mandate is to have a pan-Canadian electronic health record by 2009. How close or how far are you from meeting that goal?

RA: Although we got started late compared to the other countries, we’re making quite remarkable process, and by 2009, when you look at the basic elements of the electronic health record which are drugs, labs, diagnostic imaging and consistent registries – by 2007, every Canadian will benefit from some form of the advancement of these information systems. A province might not have all three – drugs, labs, imaging – but they’ll have at least one. And 50 per cent of Canadians will have all three available through their clinicians.

ITB: What about the wait times strategy? What relationship does the project to improve wait times in hospitals have with Infoway’s mandate?

RA: One might say we’re on the periphery of measuring wait times. A good example would be diagnostic imaging. We have anywhere between 45 to 50 per cent of the country moving away from X-rays to digital images. Basically you’ve now got 24/7 access to a virtual radiologist. Nova Scotia is a classic example where they are completely digitized – the entire province is digitized. They can send a patient digital X-rays to on-call radiologists in urban centres, if they are getting enquiries from rural centres, and instantaneously getting read and diagnosed. What has happened there is it has improved throughput. The radiologists who were in short supply, their productivity has gone up anywhere from 20 o 25 per cent. Canadians are not getting moved around in ambulances from one facility to the next because they don’t have a radiologist. They can read the images somewhere else. All of that leads to helping with the wait list situation.

ITB: The privacy issues around these records never seem to go away. What kind of a progress check would you give in terms of addressing those?

RA: Right now we share the luxury, I think, that 85 per cent of Canadians, according to Ekos, are in favour of electronic health records. They are concerned, obviously, about their privacy, but when it is explained to them that there will be an audit trail for these systems and any unauthorized access will be reported to them, the comfort levels go up. Also when it is explained to them the difference between these systems and the paper systems where there is very little security – X-rays, discharge notices get lost – we even had examples of medical records in downtown Toronto on a movie set. We have also in the last year or so developed a privacy and security architecture. That is showing as these systems start to get built the kind of business rules that have to get built to address security and privacy. We’ve basically worked with the provinces to try and harmonize privacy legislation and make sure it is reflected in the systems that get built. So the work is far from done. We have to be vigilant all the while. And frankly at the end of the day the benefits of these systems are so huge that they need to go ahead. At the same time, we can also say that they will never, ever be 100 per cent secure and foolproof. Which is to say legislation has to kick in and if there is misuse of these systems the penalties have to be quite severe.

ITB: How do you keep motivated when there are so many obstacles to this kind of a change?

RA: Never before in Canada has there been such excitement about the automation of health care. Never before. I mean, we’re at a level in the last little while where everyone is talking about it, there are a lot of articles about it. The provinces, I’ve got to tell you, are very motivated, and the federal government that started it all off is very interested in seeing the benefits. We have a cadre now of leadership clinicians who basically want this to happen. Yeah, we’re still going to barter and bargain of who pays and at what cost, but they are very motivated to move with the agenda.

Every emergency room doctor in Ontario has access to seniors’ medication profiles. In Alberta, most specialists are examining chronic-disease patients and in most cases they have computerized discharge summaries. They’ve got blood tests results. They have X-ray scans. Never before has that occurred. I gave the example of Nova Scotia. That’s what keeps us going and we can see the kind of benefits at the end of the road.


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Jim Love, Chief Content Officer, IT World Canada

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