Electronic Health Records—Little Has Been Spent, and Little Has Been Achieved
Posted August 23, 2019
The idea that a health care system should have electronic records of tests and procedures for each patient is extremely attractive.
The path of those who pursue the dream is littered with disappointment and delay, but there are important successes.
In 2000, a federal-provincial commitment was made to developing such a system. It was estimated that a comprehensive Canada-wide system could be done for $10 billion.
Good luck with that. As is their wont, the provinces have proceeded independently, as have their institutions and practitioners.
By 2016, Quebec institutions had created five different systems. The government announced that they would be integrated into a single system costing a further $2 billion.
An Ontario Auditor-General report in 2016 noted that they had already spent $8 billion and were still some distance from achieving the goal.
The current record holder for failure is the United Kingdom, which spent US$24 billion before giving up on their project.
Canada’s provinces are progressing at varying speeds toward the two decade-old vision. Alberta appears to be the closest. It is reaping enormous benefits although it still does not fully integrate data from doctors.
Nova Scotia has not gone far down the path. In July 2016, it announced a new province-wide system would be established following a pilot project involving 30 doctors and 6,000 patients.
A three-year budget of $13.3 million was created, three quarters of it from the federal government. The goal was that doctors and patients in Nova Scotia would be able to get routine test results and share information through MyHealthNS, a new secure online tool.
The press release proudly announced that “The system will be expanded to all other parts of the province by early 2017, making Nova Scotia the first province in Canada to offer a digital health service option provincewide.”
Accomplishments since 2016 have been much more modest. No doubt there have been some useful learnings but only 300 doctors and 30,000 patients are currently on the system. To make matters worse the province has been unable to reach a satisfactory agreement with McKesson, the current software vendor. Spending to date has been $8.5 million ($2.1 million of it provincial).
The province has only recently begun to seek a new vendor. After the termination with McKesson is formalized, there will be an 18-month period after which their system will not be available. During that time, no new doctors or patients can be added. It will be sometime in 2021 before progress can resume, a far cry from the ambitious goal announced in 2016.
That goal never made sense. Projects like this are complicated. The basic software is not the problem. The hard part is finding ways to collect the data and make sure it is accurate and used by practitioners.
Doctors need to be willing participants. That is not easy. Some are disinterested in learning new technologies. Some don’t even have computers in their offices. Those that do, may have a system of their own that they know and like.
The province only recently figured out that the doctors should be paid for maintaining the data. Inputting a test result into the system costs the doctor money in time spent, and in the patient visit that doesn’t happen because the patient can see the test result online.
Both the negotiations with vendors and project management have been managed by the Department of Health and Wellness who believe that they have the necessary resources to get the job done.
This is not the only job facing them. The province announced that a procurement process began on December 6,2016 on a project with a much broader reach than MyHealthNS: “There are hundreds of clinical information systems used by health-care professionals across the province. These specialized systems are complex and expensive to maintain. The One Person One Record solution will support health-care providers who provide care to Nova Scotians in family practices, hospitals, pharmacies, and in the home.”
Thirty-three months later, the procurement process has not announced a chosen vendor.
The best that can be said about the government’s management of this opportunity is that they have not had the kind of disaster that has plagued some other jurisdictions.
What they have to show for it is a patient/doctor system serving about 3% of Nova Scotians. There is no prospect for anything more for a couple of years.
Since the original announcement, the government has not treated this opportunity as a priority. Had they done so, they would have addressed the issue of compensating the physicians for participating much earlier.
Successful implementations of One Person One Record, and of the MyHealthNS transition to a new vendor, can produce great benefits for health care. It will make practitioners more productive. It will help attract and retain doctors and other health professionals to the province.
To achieve that success will require substantial funding, ongoing government commitment and oversight, and intense involvement in the process by those operating at the front lines of health care.
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