Ontario experts find need for electronic health records

There is an ever-growing need in Ontario to integrate technology in all areas of health care delivery, according to a group of Canadian health care experts.

Speaking at the second annual health symposium hosted by George Brown College at the Toronto Metro Convention Centre this week, the panelists — all representing various aspects of the Canadian health care system — agreed that informatics is an integral part of the future of Ontario health care.

Health informatics is the integration of technology in all facets of health care delivery.

“IT plays a critical role in decreasing critical errors,” said Mariana Catz, former chief advisor eHealth, Health Canada and technical officer for the World Health Organization. “Medical errors cannot be significantly reduced without systematical changes.”

As moderator of the panel, Catz said that in the aftermath of public events such as SARS and medical equipment sterilization issues that recently occurred at several Canadian hospitals, there is a new urgency for information access and sharing.

“SARS was managed with Post-It notes and pieces of paper,” she said, asking the audience of students and faculty of George Brown if the impacts from SARS would have been less if information were computerized.

“The information which is needed is increasingly based on data and decision support-tools that are processed, stored, and communicated using information technology,” she said.

Citing endless reports that discuss the potential deaths and illness related to system errors in hospitals in the U.S., as well as potential illness related to miscalculations on medical dosages, Catz said the common theme is the critical role IT plays in reducing medical errors.

However, it’s taking a long time to get something done, said Mary Ferguson-Pare, vice-president professional affairs and chief nurse executive, University Health Network.

“Health care is about people caring for people and people are fallible. We are doing the best we can with what we’ve got,” she said. “Informatics will contribute to quality of care and will contribute to the physicians.”

Also armed with statistics was Matthew Morgan, director of medical informatics, Misys Healthcare.

Morgan talked about the dangers of drug-to-drug interactions, or when a patient — usually a senior — on multiple medications faces the possibility of taking two drugs that could negatively affect him or her. With thousands of medications, it’s difficult for physicians to have all that information in their minds.

He said computers can provide alerts for physicians prescribing drugs to avoid potential harmful drug reactions. “Patient safety is important,” he said. “If we cut down on the number of errors it can save this system money.”

Morgan also said it was time to move away from the paper and pen and into electronic health records (EHR). “We are asking [health care professionals] to work in an environment without the right tools, or to rely on memory. That’s just not right,” he said, adding that ERH is essential for safe, effective and high-quality care delivery.

Focusing on oral health, Fran Richardson, registrar and chief administrative officer, College of Dental Hygienists of Ontario, said it’s time to connect the mouth back with the body.

“Oral health has been disconnected from the health care system,” she said, adding that there isn’t integration between oral electronic databases with hospital records.

Practitioners in oral health have a tendency to re-create new records for new patients and there is little sharing of client records. With communication across the hospitals and the oral health facilities, there will be better communication within the system and less duplication of effort. She said it is time to bring the silos of information from various health care agencies together.

EHRs also raise issues of privacy. Richard Shekter, a medical malpractice lawyer at Shekter, Dychtenberg LLP, said the problem with the marriage between medical resources and technology is that if something goes wrong, “it goes wrong big time.”

Once information is electronic, there is a huge responsibility to ensure patient privacy and as such there will have to be regulations in place.

At the same time patients have the right to control and have access to their own medical information, he added.

“Records are the only means a patient has to protect themselves,” Shekter said. “It if isn’t recorded, it wasn’t done.”

Ferguson-Pare agreed with Shekter, but also added that it’s important not to lose the human factor in health care. “We have to be careful about using technology, but we have to use it,” she said.

The panelists all agreed that Ontario lags behind Alberta, which was the first province in Canada to launch an EHR for patient care in October 2003. The Alberta Electronic Health Record is a province-wide health information system linking physicians, pharmacists, hospitals, home care and other health care providers across the province. The record stores pertinent patient information online so that health care providers can access a patient’s prescription history, allergies and laboratory test results by computer.