The long-awaited Romanow report says technology will be one of the most important building blocks in the reform of Canada’s health care system.
Building On Values, released Thursday by the Commission on the Future of Health Care in Canada, is a result of a 10-month consultation the federal
commission held with provincial governments. The nearly 340 page document is a set of recommendations from the commission on how to make the Canadian health care system more efficient and sustainable.
Commissioner Roy Romanow and his colleagues give technology a prominent place in the report. One of the key initiatives recommended is a creation of a pan-Canadian personal electronic health records system. Both government agencies and health care providers are already developing these systems in several provinces. But the work so far has not been coordinated and initiatives are developed largely in isolation.
The report points out that although there is general consensus in the industry about the importance of making better use of IT, progress in adopting it has been slow.
Technology, the report says, “”can forge a strong link between quality on the one hand and accountabilty on the other.””
Michael Guerriere, managing partner and CEO of Toronto-based Courtyard Group Ltd., agrees. He marvels at the fact that such a complex and enormous enterprise as a nationwide health care system is being allowed to operate without a more modern infrastructure.
“”It’s absolutely phenomenal that something that really makes up 10 percent of the economy is still largely managed on paper,”” he said.
Guerriere points out that there are many areas in the industry in sore need of a technology injection. From the operating room to the furthering of telehealth services, there are still too many processes and procedures without access to IT.
Even something as simple as appointment scheduling is a challenge in many practices and hospitals right now, he said. Scheduling applications are not widely used, leading to unnecessary time and financial strains on patients. Things would run much more efficiently if solutions similar to what the airline industry is using were adopted by healthcare facilities, he pointed out.
“”You can imagine (what would happen) if you were going to go from point A to point B and go through a connecting city, if you got the first flight the first day and then three days later they gave you the second flight,”” Guerriere said. “”But we don’t think anything of that in health care. ‘Come to the hospital and we’re going to give you your CATscan today. Then come back three days later and we’re going to give you an ultrasound.'””
A simple process of scheduling can be a huge inconvenience for patients who have to travel hours, sometimes days, from remote or rural areas to see their doctor, he said.
“”Now there’s a certain amount of that you can’t do anything about. You live where you live, and there’s not enough volume to justify building a hospital in every small town,”” Guerriere added.
To address that issue, the report calls for the use of money from the federal Rural and Remote Access Fund to expand telehealth services.
That’s very good news for organizations like the NORTH Network. The telemedicine organization operates out of Sunnybrook and Women’s College Health Sciences Centre in Toronto and has been able to provide support services to 75 sites across Ontario. Some of the communities it serves are so small that they not only have no local hospital, they don’t even have a doctor, pointed out NORTH Network director Dr. Ed Brown.
“”We’ve partnered with a number of First Nations communities that are remote and have no doctor. So we’re supporting the nurse that’s there or the community health worker,”” he said.
With help of videoconferencing equipment, NORTH Network has been able to provide patients with remote access to specialists in over 40 areas of medicine. The network has now also been able to roll out its first emergency services program, which has doctors on call 24 hours a day to assist in management of stroke patients, Brown said.
Telehealth is a great tool to improve delivery of healthcare services for provinces like Newfoundland, which has about 50 per cent of its population living in rural areas, said Dr. Carl Robbins, professor of family medicine at St. John Nfld.’s Memorial Hospital.
Robbins, who also chairs the Telehealth and Educational Technology Resources Agency at the hospital, says that telehealth can be a great cost reducer for patients.
But Robbins said telehealth should not be treated as the ultimate solution to rural and remote area health care woes.
“”We’ve had a number of evangelists out there almost pretending that it is a panacea and that you don’t need physicians and nurses in remote communities because you have telehealth,”” he said. “”Nothing could be crazier and further from the truth, or certainly further from the agenda I happen to hold.””
Guerriere agrees and said that the multi-layered primary care reform the report calls for cannot be done properly without first investing in a proper national IT infrastructure for the health care providers.
He worried though, that the relative lack of political sparkle this topic has may mean that in the end the technology section, though prominently displayed near the beginning of the report, may end up lost in the shuffle.
“”The entertainment value is not very high. So it’s always something that people say, ‘well yeah, you have to do that, it’s important. But let’s talk about the stuff that causes political sparks,'”” he says.