When it comes to information technology, many Ontario medical practices are still more “Leave It To Beaver” than “Jetsons.” In that respect, Canada is falling behind other developed countries in integrating health care through new technologies.
Richard Alvarez, the recently departed President and CEO of Canada Health Infoway has many regrets over what he has been able to achieve after 10 years at the helm of the agency charged with coordinating federal and provincial investment in health care innovation and information technology.
Speaking at Longwood’s “Breakfast With The Chiefs” last week, Alvarez remained careful about his choice of words before a room full of the health sector’s leading decision-makers.
He needn’t have bothered.
Most in the audience appeared to agree that the spread of IT technology has been far too slow in Canada – “even in the face of evidence.”
Alvarez says Infoway has been successful in the spread of electronic medical records into doctor’s offices, but “what are they doing with them?”
With the ghost of the e-Health scandal still dogging Ontario, patients have seen little direct benefit from the spread of IT in the sector.
Most medical practices do not allow you to make an appointment on-line. Alvarez describes e-prescribing as a “total failure,” patients have too little access to their own health record and most Ontarians still cannot do something as simple as e-mail their doctor.
Alvarez says the next wave should be about the “consumer,” including the ability to integrate the information generated from new the wave of personal monitoring devices directly into a health record. Patients should also have more control of their health record – giving them the choice whom to share it with.
Describing it as a low-light, Alvarez expressed frustration at physicians who still rely on paper records. Those records do not allow them to, for example, pull the files of patients who have had a heart attack within the last six months.
“There is a lot of rhetoric around patient-centered care,” he said. “Patient walking around with file folders and no on-line scheduling – I don’t think so.”
The next job for Infoway is getting adoption and clinical value from this new technology.
The present piecemeal development means that doctors cannot necessarily see records in context as they toggle between existing systems. That needs to change.
Other countries have leaped far ahead of Canada – Alvarez says that Australia and New Zealand are now in their fourth or fifth wave of development.
“There are great clinician leaders,” he says of Canada, “but not enough of them.”
That pressure for change may come from the users of the health system. Canadians are becoming more demanding as patient groups are getting organized.
Alvarez says that they continue to be concerned about access even with more physicians than ever. “Twenty per cent of Canadians still do not have a regular doctor.”
He says more incentives need to be placed on reducing demand – not just on the supply side of the equation.
That includes, for example, incentives for going to the gym.
Alvarez says the e-Health scandal “screwed up the procurement process across the country. They have been in the penalty box for that.”
It’s not like there aren’t success stories, and Alvarez was quick to remind the audience that TeleHealth is world-class and that change is underway in many parts of Ontario where physicians are getting more comprehensive patient information.
He says we need to be working on an interface with smart phones and other new technologies or “we are going to miss the boat.” Patients could be developing their own repository of information on these technologies.
Information technology can be an enabler towards an integrated system – something Alvarez denies we have right now.
“I’m extraordinarily optimistic that there will be more change in the next five years, especially in this province,” he said.
Asked whether privacy laws have been an impediment to the spread of IT in health care, Alvarez called it a red herring, noting that former Privacy Commissioner Ann Cavoukian “never wanted privacy to be an excuse for not sharing info.”
Health Canada has also ruled, for example, that there are no impediments to e-prescribing.
Alvarez lauded the target new deputy health minister Bob Bell has set to make Ontario’s health system world-class at the best price within five years, but said that he is going to have to take risks to bring about that target.
“Understand that there are going to be some failures – that’s the nature of risk,” he said.