Wednesday, July 02, 2008

Canadian Health Records Situation A Travesty

Janet French | The StarPhoenix | Wednesday, July 02, 2008

Canada's foot-dragging on embracing electronic health records is a flaw in the system as revealing as a patient's paper hospital gown, a longtime national health reporter says.  Globe and Mail public health reporter Andre Picard told a Health Quality Council conference on transparency in Saskatoon Friday the nation's lack of electronic health records is a "travesty" that helps make personal health information tricky to get and hard to understand once you do get it.

"Metaphorically, our butt-cracks are showing," he told about 200 conference attendees, who tittered at the remark.

Canada's health system needs to break out of the culture where basic health information -- including your blood sugar readings, blood pressure, cholesterol levels and how those numbers change over time -- is rarely shared with the patient and treated like a "state secret," Picard said.

"We're still in the era of paternalism," Picard said. "We're changing, but we're not changing quickly enough."

Picard gave the example of returning from a trip to Malawi with a parasite. When Picard asked his specialist what the name of the parasite was, the doctor was puzzled about why he wanted to know.

"Why do I want to know what's living in my body?" he said. "I just couldn't believe the arrogance of that. But it's not that uncommon, unfortunately."

The information in medical records belongs to patients, not health-care providers, he says. Standardized, electronic records available throughout the system would simplify access, Picard says. Patients might fare better if they approached health care like they shop for a vehicle, Picard said later in an interview.

"If you go to buy a car, you want the manual," he said. "If you get it fixed, you're not only going to get the bill, you're going to get an explanation of what went wrong and maybe you can avoid it happening the next time. It's the same philosophy."

Too many patients are compliant when they'd be better off asking questions, he said. "They have a great deal of respect for their physicians, which isn't bad, but it's taken too far. We just sort of take their word as gospel."

There's a bonus to inquisitiveness: Research shows engaged patients are healthier, less likely to experience a medical mistake and cheaper for the health-care system, he said.

"I think he's right," said Jean Morrison, the Saskatoon Health Region's vice-president of performance excellence and chief nursing officer, after Picard's talk. "We're a public institution, and people have the right to their information and they have a right to information about what goes on within public institutions."

Bobbylynn Stewart, the region's acting privacy commissioner, says it's "very easy" for patients to see their health records. The department will make copies at 25 cents a page and if an inpatient requests to see his or her chart, a staff member will explain what the jargon means.

Morrison admits many patients would not be able to understand their records without help. The region strives to eventually include a written analysis of tests in the notes to make records more comprehensible, she said. Although lab results, prescription information and diagnostic images are now computerized, Morrison estimates less than one quarter of the region's health records are electronic. The region would like to be paperless, but the provincial government will have to pony up the cash to make it happen, she says.

"Creating electronic records is a costly business because you are truly transforming the health system," Morrison said. "It's the software, the hardware, it's the training of the people, it's the way you do business. It's a multi, multimillion-dollar issue to do that. In the Saskatoon Health Region, we're talking tens-of-millions of dollars."

For skeptics who think information should be kept tightly under wraps, Picard points to Canada's tainted blood scandal, or the Newfoundland scandal where flawed breast cancer tests were done on women for eight years before the health authority admitted the errors.

"We can look at all kinds of elements that came into play, but No. 1, the starting point for that, was people covering up information and not being open about it," he said.

"In my experience, the price of secrecy and the price of paternalism is dead patients and wounded patients," he added.


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