Technology has had a tremendous impact on the products and methods we use to get healthy and stay healthy, but when it comes to healthcare delivery, technology has been vastly under employed.
Today’s information technology offers several valuable benefits to the total health care system
in Canada, including timely exchange of patient information between care providers, Ministries of Health and insurance companies; improved accuracy in prescribing tests and medications; and more effective clinic management.
IT offers increased professional development through e-learning, online access to the most current information, and improved physician-to-physician communication. Information regarding population health and immunization rates can also be gathered to help governments paint an accurate and timely picture of Canada’s health.
These benefits end up having a significant impact on patients. Aside from better service, patients won’t necessarily have to pay out of pocket. Using IT, care providers can coordinate various benefit groups so that if a patient has several insurance policies that come into play (for example a company policy and a spousal policy) they can easily be combined to cover the costs of the appointment. For the care provider, it’s as simple as a few mouse clicks. That means your next trip to the dentist is painless, at least financially.
While the advantages of using IT to improve healthcare provision are clear, there are several challenges that have, until recently, acted as barriers to the implementation of information technology.
High costs traditionally associated with technology have discouraged decision-makers in an industry that is already considered strapped for resources. The issue of security and privacy is also a paramount concern, as it should be when it comes to dealing with personal information. Technical complexity is another issue. After all, the goal of care providers is the delivery of healthcare — they shouldn’t have to learn a new trade like computer programming to be able to do their billing. Simplicity is the key.
There’s already a fair amount of complexity inherent in Canada’s healthcare system. In Canada there are 10 public payers (the Ministries of Health), 10 Workers’ Compensation Boards, approximately 30 large private insurance companies, and many third party administrators of health benefits programs.
In most cases, separate adjudication systems exist for each health segment such as dental, drug, medical, and extended health. What’s needed is one comprehensive, end-to-end solution that can link all of these parties together while improving healthcare delivery at the same time — a problem that IT can solve.
Governments have realized the potential of IT. Ontario’s Family Health Network and Alberta’s Wellnet program are recent examples of how governments are looking to use technology to reform primary care provision. The type of solutions they’re looking at need to stand up to the challenges outlined above, and then some. That being said, there are several qualities the successful candidate must have.
Going to see a specialist – experience
You wouldn’t rely on your doctor to check your teeth or your dentist to tell you what medicine to take. Knowing who has the right answers and the experience to back up those answers is essential for ensuring the success of IT in healthcare. Using companies that all bring significant experience on given subjects is essential.
Knowing the industry is one thing. Recognizing and taking advantage of experienced partners is another, and it’s a key component of an end-to-end IT solution for healthcare delivery.
Testing your reflexes – flexible
With a healthcare system as complex as Canada’s, saying that the right IT solution has to be flexible is an understatement. Aside from new systems being implemented, the right IT solution has to account for the transparent integration of legacy systems as well. This applies to the electronic networks of the Ministries of Health and private insurance companies.
The right solution also has to consider care providers at every level, ensuring they’re equipped with hardware, software, connectivity and support. Applications should be easily accessible and generally based on an open systems framework so that care providers aren’t limited to using a specific technology. For instance, some solution run in a browser interface and through Microsoft Outlook; the operating system and browser on the client machine don’t make a difference.
Being a general practitioner – functional
How functional an IT solution is determines the real benefits for patients, care providers and the general healthcare system. It may look nice, but if it doesn’t serve a purpose there’s no point in having it. A strong solution takes into account clinical functionality, billing and payment functionality, and administrative functionality.
IT promises a wealth of new possibilities for care providers in terms of clinic management. For example, one solution has doctors, dentists, and other care providers creating electronic medical records that can be accessed anywhere.
Patient demographics, family histories and test results can all be easily managed. Scheduling is also controlled, allowing care providers to avoid resource conflicts by tracking workflow and delegating staff, and prevent cancellations or no-shows through various reminders to contact the patient when a check-up is needed. Hospital and lab information systems and medical and drug reference information from Health Canada are integrated so that care providers can access the information they need when they want it.
To streamline billing and payment, solutions should take into account numerous payer organizations such as the Ministries of Health and insurance companies. Streamlining the process by interfacing with Ministries of Health for things such as enrollment forms, billing reconciliation, and health card validation; and with insurance companies for immediate policy validation is necessary. This means care providers can do their billing online hassle-free, coordinating with as many payers as needed for any given patient.
Finally, the administrative functions can’t be overlooked. Collaboration tools like email, and search and reporting capabilities are prerequisites for any strong solution. Allowing for predefined and ad hoc reports to be generated in various formats could be helpful.
The solution should incorporate connectivity to link to various organizations, by no means is it dependent on it. The solution should support full offline capabilities as well, allowing care providers access to contacts and scheduling information. Of course, if it’s a simple matter of a clinic’s broadband Internet connection going down, a dial-up connection can be used as backup.
All of these features are designed to improve patient care by delivering information to care providers where they need it most: at the point of service.
Having a clean bill of health – cost-effective
It should come as no surprise that cost is a large consideration when deciding on the right healthcare solution to implement. Aside from the investment in the infrastructure, there’s also the costs that care providers must take into account in order for them to be set up on the new system. Clinics will vary in terms of their involvement with the system. For example, small clinics with low patient volume may opt for a scaled-down solution whereas larger operations may demand a more robust setup. Either way, pricing has to be affordable.
The Application Service Provider (ASP) model lends itself well to healthcare as it allows many organizations to be networked easily in a cost-effective manner. The only thing that care providers need worry about is paying a small bill each month. Deploying an IT solution over a thin client and having installation and upgrading done automatically ensures a low cost of ownership and low support costs.
Alberta-based Ware’s subscription-based pricing, for example, offers insight on how affordable an ASP solution can be. For use of the application a clinic can expect to pay between $50-$100 a month, while a turnkey solution involving hardware, software, onsite support, training and data backup runs approximately $600-$800 a month.
Software licensing is also a factor, and delivering on an open platform can pay big dividends in this respect. Healthcare IT solutions should be deployed using Linux, MySQL and Apache Webserver, resulting in almost no third party license fees.
Hitting a growth spurt – scalable
While improving primary care delivery in the here-and-now is the primary goal of any good IT solution, it can’t be a flash in the pan. Any model that’s implemented needs to be sustainable in the long-term. Using an open framework to develop a solution doesn’t limit your ability to react to changes in technology down the road.
In terms of the size of any given solution, a scalable setup that can run for the masses on a mainframe, server cluster, or on a stand-alone basis on a particular notebook gives care providers the flexibility they need to grow as they see fit. The ASP model also takes growth into account. For example, ebill.ca currently resides in one of IBM’s data centers. As the system expands to include more and more care providers, it’s a simple case of IBM turning on the tap, so to speak.
Increased bandwidth, processing power, and storage are all readily available should the need arise. Larger processing volumes associated with the growth of the system are also easily handled by NDCHealth, a company that processes more than two billion transactions annually.
Respecting your patients – security and privacy
By far the most important issue in provision of healthcare through IT is that of security and privacy. Personal information is at stake and many corporations’ reputations are on the line. It’s no surprise then that a major key to deployment of an IT solution is meeting legislation set out in the Health Information Act with regards to security and confidentiality of information. There are two areas that any successful solution must include in order for information to stay in the right hands: data security, and physical security.
Data security involves making sure that those who are entitled to information are able to see it, and those who aren’t entitled can’t gain access.
The first step in the process involves user authentication. User authentication works on two of three possible levels: something you know, such as a user ID and password; something you have, such as a smart card, or a USB-based eToken that plugs into any notebook or computer; and finally something that proves who you are, such as a biometric device like a fingerprint scanner. Using any two of those levels, users validate who they are and gain access to the information they’re permitted to see and edit.
The second side of data security involves protection of the data from interception and hacking. WARE’s ebill.ca and eHealth solutions both use 128-bit Secure Sockets Layer (SSL) encryption, the same encryption commonly used in online shopping and banking applications. Encryption is also used at the database level to prevent hacking.
Aside from the protection of data, physical security is also a concern. Ensuring that no one can tamper with servers, or that the infrastructure is safe in the case of a disaster is vital considering public healthcare is at risk.
In the case of ebill.ca, IBM’s data centre provides ample security. Essentially a building within a building, the facility is protected from security threats and environmental hazards and is equipped with redundant connections to the Internet. Diesel generators, UPS backups, and separate power grids make certain that the power never goes out, and systems monitoring the supply are so accurate they can easily detect disturbances in the grid before the power company does. Security checkpoints at the data center limit access to the facility, and the cabinets containing servers and other equipment can only be opened with configurable electronic keys.
All of these measures are in place to ensure that public information is as secure as possible. Security and privacy is a critical factor in the development of healthcare solutions. A solution may be deep, but if you can drive a truck through it and steal data, functionality means nothing.
Today healthcare is on the precipice of something exciting. With governments poised to reform primary care provision, and the technology and solutions able to answer the important issues that once held them back, dramatic changes are imminent in the way healthcare is provided.
The latest report from the World Health Organization ranked Canada’s healthcare system 35th in the world out of 177 countries, a standing that shows we’re a global leader in the industry.
The report cited two goals of healthcare: to improve health, and to be responsive to the legitimate demands of the population. By improving delivery of healthcare through IT, making it easier for patients, care providers, and payer organizations, one can only hope that it will contribute to an overall improvement in the health of Canadians down the road, and perhaps a higher ranking the next time they take a look at us and realize that we’re in better shape than before.
John David is president and CEO of WARE Solutions.