Healthcare leaders offer opinions on electronic healthcare adoption

Technology, telehealth and electronic record adoption are not occurring rapidly enough among health practitioners, but the existence of incentives and removal of disincentives will accelerate the rate of adoption. A conference in Toronto earlier this year brought together healthcare opinion leaders to discuss the state of electronic health and electronic health records. During the event they shared their take on progress in the use of the electronic health record."The value proposition for e-health is better healthcare," explained Bill Albino, CEO of Smart Systems for Health Agency (SSHA), a Toronto agency which is pursuing a long-term goal of creating a voluntary electronic health record to allow healthcare professionals to access patients' lifetime health histories."The majority of electronic health has been pushed out through the practice community," said Albino. "Electronic health is getting into the public consciousness."Albino cites the Ontario Telemedicine Network (OTN), which provides 30,000 teleconsults annually and has 800 points of service across the province, as an example of telemedicine success and telemedicine in action. The re-organization of healthcare in Ontario, through the creation of local health integration networks (LHINs), has had a positive impact on the diffusion of electronic health across the province, he added."I think it's easy to see the glass half empty, but I think the glass is filling very quickly," said Albino. One of the great obstacles to the expansion of the electronic medical record and augmented use of telemedicine throughout Canada is the availability of infrastructure to execute applications that require larger bandwidth."Connectivity is an issue," said Albino. "The number one classic complaint we receive is that more bandwidth is needed. If more hospitals use applications such as PACS (picture archiving and communication systems), they need bandwidth and they need it quickly."Roger Girard, VP and regional CIO at Niagara Health Systems, said the existence of organizations such as Canada Health Infoway (CHI) are assisting to accelerate the development of the electronic health record."The funding from Infoway helps," he said. "While there is not a precise algorithm for funding, it will attract matching funds from the provinces."Girard noted that when CHI was first established, the budget for the creation of the electronic health record was projected at $10 billion, but it has since been revised at close to $14 billion. "We are increasing the amount of money we are investing, but the healthcare system is continually cash-strapped, so it is a challenge," he said.Electronic health needs to evolve into the "new normal", according to Girard. He likened telemedicine to the use of the Internet in the mid-1990's, which was not yet widely used."The use of it spread quickly," said Girard. "It was more of a curiosity in 1996, but its use is now common."Some programs such as PACS, a medical imaging system dedicated to storing, recalling, displaying and printing digital images, are routinely used in Canadian healthcare. A body of expertise is continuously developing around the OTN and the ability to hold two-way communication between physicians and patients over time and space.The integration of telemedicine programs such as PACS into Ontario hospitals and the phenomenal growth of teleconsults via the OTN has occurred despite the lack of a standard payment mechanism to remunerate Ontario physicians, added Girard.Chris O'Connor, director of medical informatics at the Trillium Health Centre in Mississauga ON, noted that for the vast majority of practitioners, there has been little change in their patterns of practice despite ongoing advances in technology that can be incorporated in medical workflow. Electronic health is rarely a topic that is discussed in medical rounds in hospitals."Doctors may go to school for 13 years to learn how to become a neurosurgeon, but they don't want to take the time out to learn a new computer system," said O'Connor.Sadly, Canada woefully lags in its adoption of the electronic medical record, estimated to be only as high as 30%, compared to other countries such as Denmark, the Netherlands, and New Zealand - nations that boast upwards of 80% adoption rate of the electronic medical record among physicians.O'Connor said Canadian physicians need to be more involved in advancing the use of the electronic health record and that they should receive academic credit for learning about electronic health. "The technology is out there, but we are not stepping up to it," he said. "If we advocate for a cause, we usually get what we want. If we step up to the plate, we will be able to have influence on this issue."Medicine must catch up with other business areas, such as financial services, in incorporating technology in day-to-day practice, according to O'Connor.Getting the right information to the right place and to the right patient should be the overriding principle that drives electronic health and the development of the electronic record, says Bill Pascal, CTO at the Canadian Medical Association in Ottawa. Pascal added that support for physicians to incorporate the electronic health record in their practice has been sub-optimal. Moreover, the process to integrate the electronic health record in day-to-day practice has been one that has not permitted innovation to flourish at a local level. "It's a question of control versus laissez-faire," said Pascal. "All the plans look to be designed as top down."The panellists acknowledged that when clinicians update their practice with new technologies and adopt an electronic medical record system, there would be an initial loss of efficiency as they troubleshoot software and work out the kinks of new systems."It will take time for doctors to recover their efficiency," said Girard, highlighting the long-term benefits of implementing the electronic health record in their daily activities.

Healthcare leaders offer opinions on electronic healthcare adoption

News | October 15, 2007

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