e-Health -- the shoe-maker needs new soles, part 2

Let's continue the discourse begun last article by considering the following statement:

The current Canada Health Infoway/OntarioMD Electronic Medical Record (EMR) systems strategy is flawed.
The above-noted organizations support doctors installing their favorite EMR application on their computer systems, be it from vendors such as xwave, Practice Solutions, Nightingale or the Open Source product, OSCAR -- heck, the two organizations even go as far as to fund the process!

The fundamental question that's been avoided is:
... does your doctor really have the required resources (time/expertise) to maintain his/her system?
Let's take a hard look at some of the things that are required on a regular basis; your doctor needs to:

• ensure the system is secure
• ensure daily backups are successfully completed
• ensure these backups are rotated off-site in case a catastrophic event occurs
• ensure the hardware systems in the exam rooms are maintained
• ensure tested procedures and resources are available to rebuild following a catastrophe

The list goes on...

To be honest, although these stand-alone applications do an excellent job, I'd much prefer my doctor taking the time to master the relationship between good nutrition and health, as opposed to delving into the intricacies of maintaining computer systems.

Sure, your clinic may be able to fund Information Technology (IT) resources (take for example, the Oshawa Clinic), or your doctor may have gone the "Application Service Provider" (ASP) route whereby the system is located at the Ministry of Health data-center with clinic staff connecting through a browser; however there still remains the fact that all they've done is to automate an island of information; if all health provider offices in the Province were EMR'd, (in-house or ASP), they'd still be inaccessible by other clinicians -- we'd still have:

•  instances of hospitals not being able to discharge patients because critical health information is locked up on some hard drive
• letters of apology being sent to individuals when computer systems (or components thereof) containing health information go missing
• doctors not knowing in a timely manner when their patients have been admitted/discharged to/from the hospital
• no efficient means of summarizing health data for trending/funding exercises by the Ministry of Health and Long Term Care (MOHLTC)

In other words, we'd still be missing the infrastructure to link these automated islands of information!

I can almost hear the question:
OK, you've always been a proponent of EMRs -- what's going on? What alternative do you suggest?
Glad you asked -- well, what we need each of our Local Health Integration Network (LHIN) organizations to do, is host an EMR system as a "Software as a Service" (SaaS) application -- the latter is where a hosting company provides the services of any application (could be EMRs, mail or Microsoft Word/Excel/PowerPoint functionality) accessible via a browser; this could be funded either by ad revenue or by a direct charge to the user on a time/use basis.
To read my E-mail, I log on to Hotmail or GMail via a browser -- I don't really care where the servers are located -- I just expect the mail service to be available; there's no need for me to be concerned with backups, updates to mail programs and the like -- that's all taken care of by the hosting company. If there's a an outage, a need for an update to be applied, a catastrophic event -- no problem -- I just sit back, relax and wait until the service becomes available. Why shouldn't our EMR systems follow a similar process?

Picture the situation whereby each LHIN runs it's own data-center and serves up a SaaS EMR accessible through your favorite browser! Every authorized clinician (doctor, nurse, paramedic, specialist etc.) around the globe now has access to the same patient record! Eureka!
My point is that generally, doctors don't do their own accounting, they don't service their own vehicles or their office equipment; so what's so special about IT?
When a police officer pulls you over on the highway, s/he just needs your documents to access your personal/vehicle record -- surely healthcare should be no different -- my health is just as important as my security!

To those doctors who have so far controlled the urge to implement an EMR system, I applaud your prescience; with the advent of netbook computers sans Microsoft Windows, the Apple iPad and similar tablet offerings from other manufacturers, something's gotta give pretty soon!
Let someone else look after the IT work in the back-end -- you concentrate on the front-end, i.e. the best patient care possible.

Next month we'll discuss integrated health care -- a process that's working very well in the US; in the meantime I'll let you get back to organizing your Super Bowl party. Be safe and enjoy!

Ernest A. James

President/CEO
Regal Informatics Inc.