Some electronic health records projects are better suited for the private sector, government should focus on setting standards, says eHealth Ontario CEO Greg Reed
Three years into his job as the steward of Ontario’s electronic health records program, the head of eHealth Ontario said the organization has learned three valuable lessons about technology deployment that will help it deliver on a promise to have the health records of every Ontarian in digital form by 2015.
Reed became chief of eHealth Ontario after its former CEO Sarah Kramer left office in 2009 amid reports of lavish over spending and a scandal over untendered contracts worth $4.8 million. Apart from the earlier spending scandal, eHealth Ontario was seen by critics as foundering on its mandate and considered a laggard in the electronic health record field among Canadian provinces.
In September last year, a $46.2 million contract won by CGI Information Systems and Management Consultants Inc.to build an electronic diabetes registry for eHealth Ontario was cancelled over delays. It was reported in the media that registry has become obsolete.
“Hospitals that are part of our network are building their own chronic diseases registry, which includes diseases like diabetes, that are using the latest technology and they are very effective,” Reed said.
Today, he said, 70 per cent of Ontarians, or 9 million out of a population of nearly 13 million, have some form of electronic medical record. About 90 per cent of exam results such as x-rays, mammogram and CT-scan results are in digital form and can be transmitted via the Internet.
“About 100 hospital emergency rooms are also connected to neuro-surgeons and specialists who can receive these results and provide immediate recommendations to ER personnel so that they can act quicker,” Reed said.
The three lessons Reed learned are:
Don’t reinvent the wheel – Ontario’s 160 hospitals as well as a large number of clinics and health centres already have their own form of digital health record systems. “The problem is, these systems are isolated,” said Reed. “Our job is less about rebuilding a new system and more about connecting hospitals, physicians and clinicians.”
He said “there were parts” of this strategy to concentrate on developing the underlying structure to connect disparate e-health systems before he came to office, but eHealth Ontario is now focusing more on this strategy.
It’s not all government’s work – A lot of private companies are better suited for developing end user technology and services. “Our role is to set the standards and fund the programs to foster e-health,” said Reed.
For example, he said, he doesn’t see e-Health Ontario concentrating efforts in software development or building mobile solutions for healthcare workers. “We don’t build EMR software,” Reed said. “We come up with privacy and security requirements, the operational specs and if private firms can deliver them then they get the go signal.”
Focus on early impact – Projects that have an immediate impact on users are vital, according to Reed. By working closely with doctors and clinicians on the ground, eHealth Ontario is able to focus on what they need urgently, he said.
For instance, he said, he was not able to grasp the real importance of patient database and prescription data bases until healthcare providers at the Ottawa Hospital explained that they used the system to crosscheck and determine how changes in prescription drugs affect patients’ recovery time after a procedure.
Patient re-admission can be cut down if they are seen by their family physician or doctor within a week after their operation. The problem is, with the old system it took doctor’s two to three weeks to receive the report on procedures a patient has undergone or new prescription or drug dosage the patient is taking.
With the twin registries, doctors are able to get the information within an hour.