IT Could Cut Canada's Health Care Costs by About $7B Annually

November 13, 2007 | Creation of Canadian electronic health records (EHR) system could save billions in costs annually. President of Canada Health Infoway predicts huge reduction in need for diagnostic tests, fewer days in hospital.

Richard Alvarez, President of Canada Health Infoway, the country's planned health information sharing program -- said that more effective information management through the use of IT could reduce national health care costs by $6 billion to $7 billion Canadian, or about $6.24 billion to $7.29 billion, annually, Charlottetown Guardian reports.

The savings would come from reducing hospitalizations based on unnecessary drug interactions and a reduction in duplicate diagnostic tests, the Guardian reports.

The Canadian federal government plans to invest $1.6 billion Canadian, or about $1.66 billion, into Health Infoway and leverage another $1.6 billion Canadian, or about $1.66 billion, from provincial and territorial governments.

"This is a $10 billion (Canadian) project all told by the time it is completed and we expect that to happen over the next 10 years," Alvarez said.

Alvarez said the nationwide health IT program will "start with hospitals, then pharmacies and community clinics, and probably the last to come on board will be family doctors' offices" (Original article from Charlottetown Guardian, 11/13).

U.S. Poll: Most Adults Say EHR Benefits Outweigh Privacy Risks

Nearly two-thirds of U.S. adults believe that the benefits of electronic health records outweigh the privacy risks, according to a new Wall Street Journal Online/Harris Interactive poll, the Wall Street Journal reports.

Three-quarters of the survey's 2,153 respondents said they agree that patients would receive better care if doctors and researchers were able to share information more easily through electronic systems. Similarly, 63% said that using EHRs could reduce medical errors, and 55% said EHR sharing could reduce health care costs. However, about 25% of respondents said they are unsure if EHRs can provide these benefits.

The survey, which was conducted between Nov. 12 and 14, also found that about 25% of respondents said they currently use some form of EHR. Of those, 23% said the EHR is maintained by their physician, while 2% said they created and maintain their own personal health record on their computer. Fifty-six percent of respondents said they do not have an EHR, while 17% said they are unsure if they have an EHR.

The poll indicates that privacy concerns still remain among health care consumers. Half of those surveyed said EHRs make patient privacy more difficult to ensure, down from 61% in 2006. Twenty-five percent of those surveyed said EHRs would not make it more difficult to ensure patients' privacy, while another 25% said they were unsure.

November 29, 2007 from iHealthbeat

eHealth Leaders | Mississauga Hospitals sharing patient records

Over the past years, several hospitals, and commercial vendors have announced personal health record projects. Few of these are widely deployed, and few are fully integrated into ambulatory or legacy hospital-based electronic record systems. The earliest adopters of personal health records have many lessons learned that can inform these new initiatives.

Today’s Health information technologies allow for comprehensive management of medical information and its secure exchange between health care consumers and providers. Widespread adoption of information technology is now commonly regarded as a pathway to improving health care and patient outcomes. Because of these technologies, people everywhere are increasingly benefiting from web-based information technology, and savvy web-users are finding the outdated information systems traditionally associated with delivering healthcare nonsensical.

Antiquated IT systems and processes combined with poor information flow are increasingly resulting in systemic under-use, and misuse of healthcare services. Add to this the pressure from the full spectrum of consumers, payers, and policy makers—and all eyes are on the sources of wasted resources, operational inefficiencies, and unsafe care.

The resulting call for a significant restructuring of our Canadian healthcare system is coming from the highest levels of government, demanding that the industry take advantage of the time, cost, and resource efficiencies promised by healthcare information technology– including electronic health records (EHR) and web-based information exchange. To put the fundamentals in place in Canada will conservatively cost between $10-billion and $12-billion, or about $300 for every Canadian citizen, according to a study by consulting firm Booz Allen Hamilton Inc. However, returns would be enormous, amounting to about $6-billion a year, in the form of improved quality of care, better safety and greater productivity.

Light at the end of the tunnel
Advances in health information technology (IT) enable a fundamental redesign of health care processes based on the use and integration of electronic communication at all levels.

Most would agree that achieving our Canadian goals requires fresh approaches to health system design, including amongst other things, extending the relationships between physicians and patients (and the tools to help patients be active participants in their own care.) This path improves public health one individual at a time, by building partnerships between health care consumers and providers across the country. However, in order to accomplish this, an honest discussion is required regarding the current standards for system design, evaluation, reimbursement, and usability.

Somehow, hospital leadership must enable their organizations to evolve while protecting the financial stability of their institution and the well-being of the patients. This includes providing the modern tools, training, and support to move forward and evolve their health delivery platform. This can be accomplished incrementally by growing the universal understanding of viable, effective technologies---and more importantly sharing our successes and failures as an industry.

There is no longer any choice about joining the eHealth revolution. It is becoming the rule, not the exception—and it is gaining momentum everywhere. A proven eHealth portal solution not only leverages, enhances, and augments existing IT investments, but also simultaneously evolves information delivery platforms towards a more open, vendor-neutral, patient-centric environment. Moreover, it is not meant to replace any legacy systems, rather reside “on top of” or in collaboration with any/all existing systems.

eHealth Leaders
The Credit Valley Hospital, William Olser Health Centre, and Halton Healthcare Services in Mississauga, Ontario today are sharing patient data through a Web-based electronic healthcare record (EHR) viewer, ensuring all three sites can securely share all patient records—regardless of legacy IT systems or vendors. This extended ability to share patient records promises to have a dramatic effect on improving patient safety and operational efficiency by reducing redundant treatments and medical errors.

The Credit Valley Hospital is the latest Canadian hospital to implement Agfa HealthCare’s IMPAX® Clinical Dashboard™ eHealth portal solution (powered by MEDSEEK®). Deployed in just over 90 days, the Dashboard™ extends vendor-neutral, enterprise-wide IT system interoperability between the three disparate hospitals. Today, users have the ability to easily access critical patient information from any PC, handheld, PDA, or tablet PC with Internet access. Data can be retrieved from any of the three facilities – whether it resides at William Osler Health Centre’s two sites (Etobicoke and Brampton) or the three sites of Halton Healthcare Services (Oakville, Milton, Georgetown). The portal solution has the ability to serve the nearly one million residents currently living in Mississauga, Brampton, Halton Hills, and Oakville.

“Due to the regional programs at The Credit Valley Hospital, it’s critical that all departments are able to share data amongst providers and partners, while providing a complete, up-to-date patient medical record,” said Dan Germain, vice president, CFO and CIO, The Credit Valley Hospital. “Agfa’s solution integrates all patient clinical data with the other healthcare facilities in the region, facilitating LHIN-wide, province-wide and even nation-wide data-sharing.”

Building on this first stage in a long-term eHealth portal strategy, The Credit Valley Hospital plans to eventually extend a patient portal with dynamic transactional functionality to its regional constituents, promising to have a dramatic effect on wait-times and patient safety, while significantly reducing costs and redundancies, such as test duplications due to missing or unavailable information.

“Connecting The Credit Valley Hospital, William Olser Health Centre, and Halton Healthcare Services is a great achievement for the Mississauga region. It is the first step to enhancing patient care, and creating a national EHR platform consistent with Canada Health InfoWay’s EHR Blueprint. Agfa’s proven federated portal model is a ‘win-win’ situation for hospitals – simple in premise, and deployed at a fraction of the time and cost of competitors, with immediate return on investment,” said Dieter Pagani, director of Agfa HealthCare’s enterprise solutions group. “These hospitals are truly eHealth leaders in Ontario, and have taken a quantum-leap towards eliminating the traditional barriers associated with sharing data.”

According to their website, Agfa HealthCare’s Enterprise eHealth solutions, including the IMPAX Clinical Dashboard, extend interoperability, process automation, and workflow connectivity for clinical and business functions across multi-departments and communities of users, both inside and outside the hospital. Agfa Enterprise’s eHealth solutions are also “customized for each hospital’s and user’s needs, and built on a complimentary core foundation that is web-based, scalable, extensible and focused on delivering fast return on investment. “

Adopting a federated (Horizontal) architecture
The federated (Horizontal) architecture demonstrated in the examples above, promises to fundamentally alter the healthcare landscape for every constituent, while simultaneously leveraging all legacy investment with quality and cost advantages not typically seen in healthcare.

To remain competitive, hospitals will soon have no real choice but to further transform their delivery platform. Organizations unable or unwilling to keep up are in danger of losing their competitive edge. The trick is to survive the transformation without multi-restarts, multi-level failures and multi-millions wasted. The potential to succeed however has never been clearer.

The good news is that a proven model is apparently available that delivers rapid, convenient access to any and all lifetime patient medical information from anywhere, regardless of when and where the care was delivered. Such a system is easily deployed, satisfies the need for immediate cost effectiveness (ROI), and dramatically increases productivity. Ultimately, such a platform creates a healthcare environment that provides both patients and providers with improved outcomes and higher satisfaction (while paving the foundation to a national EHR.)

Credit Valley Physicians REACH the Electronic Health Highway
Abstract:Mississauga, ON) A recent partnership between The Credit Valley Hospital (CVH), Halton Healthcare Services (HHS) and William Osler Health Centre (WOHC) means that patient safety, satisfaction and technology will be enhanced at these three organizations. William Osler Health Centre and Halton Healthcare Services recently welcomed The Credit Valley Hospital to the REACH portal. The collaboration between six physical hospital sites in Peel and Halton regions means all of their clinicians have instant access to patient health information stored electronically at any of the hospitals through a secure network called REACH -- Rapid Electronic Access to Clinical Health information.

The electronic health information portal allows authorized clinicians access to their patients' information through a secure web browser inside and outside of the hospital environment. This means lab and diagnostic test results, images, transcriptions and progress reports written at one hospital can be viewed immediately by a physician treating the patient at a subsequent visit at one of the other five facilities. Patients move between facilities for different diagnostic tests and procedures that are not necessarily performed at all facilities.
Credit Valley's patient information - health record, lab and diagnostic test results and images, transcriptions and progress reports can be easily viewed and updated with new information.

"Integrating our system with William Osler Health Centre and Halton Healthcare Services will reduce the duplication of tests and by doing so, reduce healthcare costs." says Dan Germain, Credit Valley vice president and e-Health lead for the Mississauga Halton Local Health Integration Network. "What's most important is the benefit to patients, especially in emergency situations when access to comprehensive patient information is critical."

Dr. Paul Philbrook, CVH chief of Family Medicine and current Chair of the Central West - Mississauga Halton Community Family Medicine / Public Health Network of Physicians. He and his colleagues championed the idea of allowing affiliated physicians the opportunity to access their patient records across all local hospital sites. He says "the REACH portal is a welcome advancement of access to patient information and integration locally. This will enhance patient care and safety."

"Shared access to the electronic health record is one of the most important collaborations between healthcare providers in a LHIN environment," according to Mississauga Halton LHIN CEO Bill MacLeod. Central West LHIN CEO, Mimi Lowi-Young concurs noting, "the REACH portal contains virtually all of the on-line data contained within the three hospitals and six sites for a population in excess of one million inhabitants."

The REACH web portal provides access to over 90,000 inpatient stays and 1,050,000 outpatient visits for the fiscal year ended March 31, 2007. Patient stays and visits from all three hospitals are consolidated into one web portal view for use by authorized clinicians.

The electronic health information is only a keystroke away after the clinician logs into the secure REACH network with his user identity and password. There the clinician will see a "dashboard" of patient information options to view the patient as "admitted, attending or referring" and then choosing the pertinent information fields.

Unlike traditional web portals, this dashboard is able to access clinical data from disparate systems through one unified view, enabling easy review of patients' records, lab results, cardiology images, diagnostic (PACS) images, transcriptions and progress reports. Because the ehealth record will show the patient's entire health history, important information such as medication allergies will be revealed even if the patient inadvertently forgets to mention the allergy at the time of a visit to one of the five other health facilities currently on the REACH network.

"That's especially important," says Germain, "as we move toward the integration of health information from across and between all providers within the province's Local Health Integration Networks (LHIN)." Germain is the e-Health Lead for the Mississauga Halton Local Health Integration Network.

William Osler Health Centre and Halton Healthcare Services initiated the electronic highway between their facilities more than a year ago when the Georgetown site moved from within William Osler's cluster of facilities to become part of Halton Healthcare Services. It was important for continuity of care that the patient information stored electronically on Osler's computer system became available to Halton Healthcare providers as well.

For More Information Contact:Dan Germain, CFO and CIO, The Credit Valley Hospital. Original story posted on Longwoods eLetter (December 4, 2007.)

Rebooting Canadian Healthcare using eHealth Portals

by Dan Germain, VP, Chief Financial and Information Officer, The Credit Valley Hospital as published in Canadian Healthcare Technology Magazine | Vol.12, No. 8 | Nov/Dec 2007.

According to recent statistics from the Canadian Institute for Health Information, as many as 24,000 Canadians die each year from adverse events like surgical errors, patients receiving the wrong medication, and hospital-acquired infections. As the practice of medicine today is inherently dependent upon healthcare technology, the accountability and sustainability of our healthcare system depends on the ability of healthcare practitioners to find ways of gaining efficiencies and increasing effectiveness in every aspect of their daily activities.

All levels of government across Canada are experiencing pressures today to cut healthcare delivery costs, while increasing the level patient safety and care. With this demand for managed care, technology is quickly evolving to meet new and more complex requirements, with significant benefits to medicine and healthcare overall. As Charles Darwin so aptly identified: “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” In the past, the acquisition of technology was viewed as the answer in and of itself. Decisions about technology and usage were typically driven by the question of how to improve the effectiveness of what hospitals were already doing. However, today’s information systems should be viewed as a vehicle to transform current hospital processes into what they could and should be doing.

At the same time, there is a demonstrated understanding for the need to update technology systems in order to extend a national electronic health record (EHR) in Canada. Healthcare stakeholders agree that technology is critical to facilitating necessary information-sharing across disciplines and venues. Driven by Canadian Health Infoway, this movement embraces the need to evolve healthcare informatics toward a more open, standards-based, patient-centric model that brings together all imperatives: clinical, administrative, financial, managerial, and human resources.

With the information-sharing capabilities provided today by a rapidly expanding number of new technologies, Canadian healthcare organizations can leverage a crucial tool-set to support informed medical decisions at the point of care. To this end, healthcare providers and vendors both agree that a consistent, standardized way to share information between healthcare stakeholders can overcome the barriers to attaining an EHR.

One destination; Many paths
When any healthcare organization sets out to extend a ‘cradle-to-the-grave’ EHR – readily accessible via the Internet and linked to clinical protocols and guidelines — most people picture only one scenario. In this scenario, a user enters a patient query into one computer system, and that query goes to one source where all the patient information has been stored in a single “centralized” database, or vertical architecture. The system searches one database and returns the queried information to the user. The problem with this scenario, is that information is not best accessed in this manner as the required patient data resides somewhere in a disparate system.

However, this is not the only option. Instead of duplicating that patient data in a new centralized system, the healthcare organization could leave the existing data in place. Then, when the user enters a query about a patient, the system logically gathers the appropriate patient data from wherever it is stored. This approach is called a “federated” database model and employs a horizontal architecture. Anyone who uses the Internet takes the delivery of content from multiple systems for granted. Almost every Web page is automatically assembled from multiple sources, and employs a federated database model. One simply clicks a button and data is retrieved from disparate databases and servers.

By definition, a federated database is a collection of data stored on multiple autonomous computing systems connected by a network that is intuitively presented to users as one integrated database. Additionally, using a federated portal approach allows bandwidth, hardware, administration, and other infrastructure costs to be distributed over time, keeping pace with the development and deployment of the facility. This can significantly reduce networking and system-interfacing costs and opens up a number of added functional possibilities by extending data to the organization’s value chain delivering clear, tangible benefits for your short and long term needs. Compared to a centralized portal, today’s federated architecture can achieve equivalent or better results, at a fraction of the cost and time.

Follow the leaders
The Credit Valley Hospital (www.cvh.on.ca) is a vibrant community hospital providing leadership in the delivery of primary, secondary, and tertiary health care services to the people of Mississauga, Ontario and the surrounding LHIN-6 region. Serving more than 5,400 visitors daily, The Credit Valley Hospital (CVH) has provided patients with access to cutting-edge medical research, programs and treatment since 1985, recently opened a new Ambulatory Care Wing that offers both systemic (chemotherapy) as well as radiation therapy as a regional Cancer Centre. By 2011, CVH will have completed another expansion adding 145 new inpatient beds to the community. . As such, it’s not surprisingly to imagine that the 2,700 staff and nearly 400 physicians generate and store a significant amount of disparate data.

CVH recently implemented a MEDSEEK Web solution which facilitates various healthcare organizations to support vendor-neutral and enterprise-wide system interoperability. Due to the regional programs at CVH, it was critical that all departments were able to share data amongst its providers. The goal was to be able to provide the same information sharing capabilities among various healthcare facilities, nation-wide, as well as reduce redundancies like test duplications due to missing or unavailable information. After implementing the federated portal, CVH saw an immediate improvement in both patient flow and medical care throughout the hospital. Today, patient-data is immediately available from any computer with Internet access, whether the disparate data actually resides at the two sites (Etobicoke and Brampton) of William Osler Health Centre (www.williamoslerhc.on.ca) or at the three sites (Oakville, Milton, Georgetown) of Halton Healthcare (www.haltonhealthcare.com). The population served by these portals exceeds one million people residing in Mississauga, Brampton, Halton Hills, and Oakville.

Agfa Healthcare’s Clinical Dashboard™ (powered by MEDSEEK) is the only proven federated portal model in the country that addressed CVH’s unique pain points in an efficient and cost-effective manner. The portal met the organizations rigorous selection criteria by offering superior software and services, clinical integration experience, and the ability to expand to future enterprise eHealth solutions. The combination of ease of use, real-time data access and enhanced clinical functionality enhances patient care and clinical excellence, while extending a virtual EHR. In addition, the solution was implemented in only 90 days – at a fraction of the cost for a centralized portal solution – which was vital.

Jeff Lamb, Executive Vice President of Sales at MEDSEEK confirms those sentiments: Enhanced integration functionality throughout a medical enterprise yields immediate operational efficiencies including reduced paperwork, improved communications, better workflow management, and stronger relationships among clinicians, patients and the community. For CVH specifically, having connectivity to William Osler and Halton Healthcare facilities, the portal provides a virtual medical record of all patient data across multiple LHINs. This not only improves physician efficiencies but also contributes to enhanced patient safety and care.

The federated portal solution evolves Canada’s healthcare delivery toward a more open, standards-based, patient-centric model, at a fraction of the time and cost of the centralized portal approach. CVH expects this solution to significantly reduce surgical and medication errors while making lives easier for staff. Additionally, as CVH expands its portal solution to support PDAs, the portal will become even more valuable as patients will be able to ask their physician specific questions and have results available immediately. Ultimately, however, the biggest winner is the Canadian patient and taxpayer.

There’s no argument about the need for a better way to access information, reduce medical errors and increase the quality of patient care, and that technology plays a critical role in making this happen. However, using technology the way it’s always been used is not the best approach for the kind of radical change needed. Through examples like CVH, it’s clear that interconnectivity and information-sharing between hospitals, LHINs, and even across provinces is a reality, and can significantly benefit from a new, “federated” way of thinking.

One Patient, One Record’ system ready for take-off in New Brunswick

The province of New Brunswick announced in September that it will invest $35.9 million over the next three years to establish a province-wide electronic health record system.

Canada Health Infoway will contribute $18.2 million to the project, with the remaining $17.7 million coming from the province.

The money will be used to put the essential building blocks in place for the ‘One Patient, One Record’ (OPOR) system. The core components, as announced, will consist of:

• an Interoperable Electronic Health Record. The Interoperable Electronic Health Record is considered a foundation piece for the One Patient One Record (OPOR) system. It will provide the infrastructure and functionality required to link, capture, store and view relevant patient information.

• a Client Registry. The Client Registry system is essentially the one-patient component of the OPOR system. With this system, each patient will have a unique provincial identifier that will tie together patient information from various clinical systems.

• a Provider Registry. The Provider Registry system will contain information on healthcare providers in the province.

• and a Provincial Diagnostic Imaging Repository. The Provincial Diagnostic Imaging Repository will consolidate a patient’s diagnostic imaging reports and images for procedures such as X-rays, CT scans, ultrasounds and MRIs, into a provincial repository.

The Department of Health has signed agreements with Initiate Systems Inc. for a Client Registry solution ($1.9 million over two years) and Orion Health for the Interoperable Electronic Health Record and Provider Registry systems ($4 million over three years).

A third contract awarded to xwave for system integration and maintenance services is worth $5.6 million over three years. The contract to create a diagnostic imaging repository has been awarded to Agfa Inc., in the amount of $9 million over two years.

Change management and training programs will also account for a large measure of the investment. And as Canada’s only officially bilingual province, New Brunswick is committed to developing solutions that work in both English and French.

“These systems are key building blocks along the journey to a complete electronic health record that will ultimately link all patient information from across the healthcare system – from hospitals, from your family doctor, from your local pharmacy and elsewhere,” said Mike Murphy, New Brunswick’s health minister.

In terms of architecture, the province doesn’t intend to pioneer new technologies or methodologies; instead, it wants to implement time-tested solutions that have a track record.

It’s hewing closely to Infoway’s standards and solutions, and it has watched carefully as other jurisdictions – Alberta and British Columbia, in particular – have gotten their own province-wide programs off the ground.

“We’re not the first to do this, but we’re going to catch up quickly to the other provinces,” said Gordon Gilman, assistant deputy minister for corporate services. “We’re a small province, which makes things easier in many ways. We think we can catch up to the others in two or three years.”

Many of New Brunswick’s hospitals are already sophisticated users of electronic health records. However, the OPOR system will provide a large measure of interoperability between the hospital systems, which are provided by many different vendors and often lack an ability to talk to one another.

The electronic health record from Orion will act as a kind of umbrella solution, accepting information from all systems and providing a viewer to healthcare providers across the province.

Carole Sharp, assistant director for projects, corporate services, at the New Brunswick government, said that a central repository will be established, housing patient data from disparate sources that will result in a comprehensive single record for each person in the province.

Healthcare organizations will keep ownership of their data, but some of it will be sent to the repository. “That will allow doctors and nurses across the province to use a viewer to see an integrated record,” she said. Sharp noted that not all data will be sent to the central repository, only that which doctors, nurses and other healthcare professionals consider to be essential.

For its part, xwave will provide system-integrator services, tying together the various solutions so that disparate systems mesh in the repository viewer.

“xwave has over 30 years experience in building healthcare systems,” said Paula Hatty, account executive with the company. “We’ve created client registries and we’ve played a key role in developing the patient wait time system in Ontario.”

Gary Folker, managing director of clinical management systems at xwave, commented that the company is well-versed in interoperability issues and Infoway’s blueprint for the design and construction of healthcare systems.

“We’re also experienced in project management, and we’re well-positioned to keep things on time and to deliver the best solution.”

Gilman commented that in addition to the four core projects, New Brunswick has also embarked on a Prescription Drug Monitoring Program, which will collect pharmaceutical prescription information at the point of dispensing – that is, at the province’s pharmacies.

The program will track dispensing of some six or seven drugs – such as oxycontin – that have been sources of concern in New Brunswick and other provinces. “We’re going to monitor selected drugs that appear to be problematic,” said Gilman. “We’ll likely share information with addiction services and police forces.”

The province has completed an RFP for the Prescription Drug Monitoring Program, and expects to select a vendor before the end of the year.

Moreover, New Brunswick will be implementing a full-scale pharmaceutical monitoring program, which will deliver information to health service providers at the point of care.

It will track the drug history of patients, provide physicians with drug interaction information and allergy warnings, in a bid to improve patient safety and the effectiveness of therapies.

Gilman noted that New Brunswick is currently in the planning stages of the project, and that planning is being conducted in conjunction with the province of Nova Scotia. “They’re developing the same kind of system, so why not do the planning together?,” Gilman commented.

He observed that it’s much easier to bring experts to the Maritimes for meetings once, rather than to request visits to different Atlantic provinces on separate occasions. While the One Patient One Record project is, for the most part, starting with large organizations such as hospitals, the long-range plan is to include all healthcare providers, such as doctors’ offices and clinics.

“The ultimate goal is to connect all sources of patient information,” said Gilman. “That includes public health, mental health services, doctors’ offices and others.” That will require additional investments in new systems. Indeed, the province estimates it will need to invest some $250 million in eHealth over the next 10 years.

By Jerry Zeidenberg, as published in Canadian Healthcare Technology Magazine, Nov.2007)

If everyone agrees, then why can’t I see my record?

In late May of this year, a large percentage of the health and medical informatics community in Canada met in Quebec City for the 2007 eHealth Conference. One regular feature of this annual conference is the Great Debate. This year the debate centered on the question “should patients have unfettered access to their health information?” I was very fortunate to be invited to be one of the debaters – on the pro side.

Before the debate even took place, the audience, of about 800 attendees, were asked whether they agreed or disagreed with the debate question. It was estimated at the time that approximately 90-95 percent of the delegates responded in favour – yes, patients should have access to their health information! And this was before the debate even started.

If so many people agree, then why can’t I see my record today? What is the hold-up? What is stopping us from moving ahead in a direction where there is overwhelming support – and this support is coming from healthcare professionals?

These are great questions that have been asked before, and we know that the answers are not that straight-forward. One major reason is seemingly banal, but overpowering: our delivery system has not accepted the idea of patient access to their own medical records.

I know, how can this be? Is this not in direct contradiction to what was stated in the preceding paragraphs? Well, yes and no.

In the abstract, yes it makes perfect sense that patients should have full access to all of their health information. In an era where consumers are becoming more involved in most every other aspects of their lives, it is reasonable to assume that the same consumers would want the same powers and freedom while managing their healthcare.

However, dealing with one patient at a time, considering the very nature of the contents of a PHR (patient or personal health record), addressing issues surrounding relevancy and privacy, the acceptance of full patient access is not as readily forthcoming. More specifically, the resistance is not, for the most part, technology-based but rather driven by a health system infrastructure and culture that cannot change… at least the way it is structured today. In other words, the system will not change until a number of issues are addressed. Below, I outline three.

First, the healthcare culture, certainly when it comes to dealing with patients, has been operating for generations with a paternalistic view. The consensus is that most patients cannot be trusted to manage their own care.

To some degree, this perspective is warranted. Further, some patients appear to even go out of their way to provide evidence in order to support this thinking. Smoking is one obvious case where there is widespread poor health management by patients.

However, it must be emphasized that this is not the case for all patients. There are many patients with chronic illness who truly want to be more actively involved and empowered. I know that, as a patient, I want to know all the facts no matter how tough they may be to deal with; sometimes understanding the situation does indeed make it easier to accept.

Second, the reimbursement structure within the Canadian healthcare system does not motivate doctors (certainly not general practitioners) to provide medical records access to their patients. While doctors most assuredly want their patients to be informed, so as to improve their health outcomes, in the end, there really is no reason to spend much time or effort, not to mention funds, to provide this access.

In fact, one could argue, that the system today actually promotes and reinforces an environment of face-to-face, one-to-one, healthcare information delivery (as opposed to electronic communication) by creating a simple payment formula – fee for service (i.e., see a patient, submit a claim).

If patients get access to information through electronic means, there will be fewer patient visits – no ifs, ands or buts! That is one of the major benefits of IT – fewer visits, lower costs overall. While it is true that the benefits of eHealth go well beyond the financial (i.e., patient safety, increased efficiencies), this is still an important consideration that needs to be addressed. In the end, what would motivate a clinician to earn less money?

Third, it is not yet an accepted fact that patients having access to their own health information improves their health outcomes. The research is still going on “in the labs”, but each month there is more and more evidence demonstrating that the empowered patient is healthier.

So, where does that leave us? It would appear that no matter how much IT development has taken place, or how much system interoperability is created or informatics training is done, I won’t get to see my record until:

1. The overall system appreciates the role of the patient as an individual and as a key stakeholder who must become active in healthcare system management.

2. The financial framework begins to motivate clinicians to support patients’ migration to feasible access of their own health information.

3. More research is funded to prove the hypothesis that informed patients are healthier.

By Kevin Leonard, PhD (as published in Canadian Healthcare Technology Magazine, Nov. 2007)

Kevin Leonard, MBA, PhD, CMA, is an Associate Professor, Faculty of Medicine, University of Toronto.