EHRs or nothing

Governments and provincial agencies will have no choice but to promote electronic health records (EHR) in a more meaningful way if large enterprises, like hospitals and health care organizations, become leaders in implementating them.

That, in any event, is the view of Sam Chebib, president and CEO of Nightingale Informatix Corp. of Markham, Ont. Chebib says his little EHR solution that grew has won some “major contracts” in the past 12 months from these “big guys.”

The only way Canada can provide quality health care and eliminate inefficiencies and redundancies is through a unique patient record for every Canadian, according to Chebib.

“How long will it take?” he asked himself. “If I was to be really aggressive — six years. Conservatively, I think in the next 8 to 10 years every Canadian will have an EHR. The key strategy is technology adoption at the health care provider level.”

Chebib still comes at the issue the same way today: “If your clinical chart still sits at your GP or specialist in paper form, that information is not going anywhere. (But) you have to start by creating incentives at the physician level to adopt technology.”

After complete physician buy-in, the least of Chebib’s concerns is extracting that information and depositing it in a central database. His major challenge, he said, is selling front-end tech use.

A study by Ottawa-based Branham Group Inc., released in early September, was surprisingly vague with respect to physician buy-in, reporting only that “the majority of nurses and physicians surveyed feel that Information and Communication Technology (ICT) improves productivity and enhances patient safety.” There was no doubt about their support for technology solutions, however: Fully 91 per cent of the health care IT decision makers surveyed felt that their current ICT budgets were insufficient.

“The obstacles that physicians face in adopting technology is (part-and-parcel) of the funding model,” Chebib said. “That model has to compensate physicians for the initial drop in their productivity.”

The current funding program has cost physicians more to do the right thing, said Chebib, who argues that anything less than 100 per cent implementation is the wrong thing.

Recent events on the US Gulf Coast helped make his point.

A week after the hurricane, U.S. Health and Human Services Secretary Mike Leavitt was quoted by The Associated Press as saying that “there may not have been an experience that demonstrates … more powerfully the need for EHRs … than Katrina.” Private sector vendors can help governments increase EHR adoption, according to Chebib.

“Maybe not directly,” he admitted, “but what we can do is demonstrate the advantages of automation in health care by showing tangible monetary benefits. That goes directly towards the cost of health care — and by improving the quality of care that is (currently) delivered.”

Chebib believes that both the Canadian and U.S. governments have acted on EHRs. “I am comfortable with the direction that the policy makers have set,” he said. “But from an implementation standpoint there are discrepancies between various jurisdictions.”

Whether it’s Nightingale or one of its EHR competitors, vendors can contribute to the over-all strategy of the various governments by participating in steering committees and information sessions, Chebib said.

“I think the policy makers are absolutely determined to move the EHR adoption rate from where it is right now . . . to 100 per cent in the next six to eight years,” Chebib said.

On that basis, Chebib is taking Nightingale public – a first for an EHR company in Canada. “We feel today that there is room to consolidate a Canadian EHR market that is quite fragmented. To be able to do that, we needed access to the capital markets, and a public offering allowed us to execute our acquisition strategy.”

Brian Eaton ( is senior writer with CIO Government Review.