E-health in crisis

Canadian health-care providers are crying poor. Doctors and nurses claim they’re pushed to the limit, without the means to grow beyond their existing IT infrastructure.
They explain why a patient can be a data silo just as easily as a server can.
Before the health-care industry can take advantage of all the benefits e-health has to offer, it’s going to need more funding, increased involvement of nurses and physicians in decision-making and improvements to communication between regional organizations.

Detailed study
These are some of the key findings from a recently released study by Ottawa-based consulting firm The Branham Group Inc. on the state of information and communication technology (ICT) in the sector today.
For the report, titled “eHealth in Canadian Hospitals: Variations on a Theme,” Branham surveyed 67 per cent of Canadian hospitals over the past year.
Of those surveyed, approximately 68 per cent felt that health care providers were not sufficiently involved in developing the ICT strategies for their institutions.
“One of the key issues is clinician health-care provider involvement in health-care decisions,” said Branham study project lead, Michael Martineau.
“Over two-thirds said they weren’t officially involved in developing strategies for their organization.”
A large majority of respondents, however, also felt that using computers enhanced patient safety and user productivity, Martineau added.
Also the director of Branham, Martineau presented the findings of Branham’s report to vendors, industry representatives and press last month.
Nurses like St. Michael’s Hospital director of clinical informatics Sally Remus agree that a huge percentage of health-care providers are not involved in decision-making.
“More traditional lines of decision-making are in effect,” said Remus, also past president and current representative for the Registered Nurses Association of Ontario (RNAO) on the Smart Systems for Health (SSH) Ontario Health Informatics Standards Committee. “There needs to be a more conscious effort to involve providers.”
Likewise, Nancy McNairn, program director of the surgical program at North York General Hospital, said the success of these projects is tied to the degree with which providers are included.
“We need to have more providers involved in the development,” said McNairn, also president of the Ontario Nursing Informatics Group (ONIG). “If user involvement is not there, the project won’t succeed.”

All about the money
In terms of funding, Branham estimates spending on e-health in Canada for fiscal year 2005-2006 will exceed $1.5 billion with half of the study’s respondents indicating IT budgets would increase.
“Most of the respondents said budgets were not sufficient enough to meet the demands placed on them,” said Martineau.
He also said that research shows on average less than 20 per cent of budgets are spent on new projects and initiatives.
“Eighty per cent of the money is spent to keep infrastructure and applications running.”
Using the United Kingdom as a comparison model — its government has committed $6 billion to its e-health initiative — Canadian Healthcare ITTrade Association (CHITTA) chairman Dave Wattling said the federal government here needs to step up its contribution.
“We have money coming into the system,” he said.
But, he added, “it’s probably not enough. Infoway has concluded that we need four times that to truly have a national e-health system.
“We’re seeing operating budgets gradually increase. It’s all peanuts. It needs to be four.”

Common themes
Despite the differences in how each of the provinces organize their health care system and deliver their services, the study revealed several common themes, said Martineau.
“We found that provinces are grouping health-care organizations from primary to acute to mental health to public health to long-term care into regional entities to gain economies of scale and to break down barriers of communication between entities so that information is readily transferable between them,” said Martineau.
Another theme is the patient at the centre of care.
As patients are referred to multiple health organizations for care, their medical information does not move with them, forcing patients to relay the same information several times as they move through the system.
A patient, for example, may go in to see a family doctor, who gives a diagnosis for a problem that a specialist needs to look at. The specialist might then refer the person to a hospital for surgery or treatment.
“As they move across (the system), in many cases they’re silos. Their information does not move. It stays with provider,” said Martineau.
“It’s patient-focused rather than provider-focused.”
Remus and McNairn, however, point out that many people, especially seniors, regard physicians as the keeper of their medical information.
“It’s a huge shift for them,” said Remus, adding that the younger generation sees the individual having more control over who has access to their medical records.

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