Is an electronic version of your health records better or not better than the paper version?
In terms of information security, it’s better, answers Donna Strating, CIO at the Edmonton headquarters of Capital Health, one of the largest integrated comprehensive health service organizations in Canada.
With an annual budget of $1.6 billion, the organization supports a range of health services delivered by 18,000 staff employed by Capital Health and partner organizations in cooperation with the 2,000 physicians working within the Capital Health region. That region includes the cities of Edmonton, St. Albert, and Leduc, plus Strathcona and Leduc counties.
“We actually have a responsibility for everything from long-term care, continuing care, home care, all the public health centres, including inspections for restaurants – everything except cancer care and mental health,” explains Strating. “Everything is under one big system here, so we are quite large.”
Information exchange takes on special significance because many patients are seen here from a tertiary referral mode and then sent back to northern Alberta, portions of British Columbia, Saskatchewan and the Northwest Territories.
“Clearly we believe that as care gets more and more complex… being able to be assured that the appropriate information follows the patient is very, very key,” she stresses. “We see the whole issue of having the ability to do electronic information exchange among multiple stakeholders, not just within our own environment, but also to community physicians, to long term care, whatever the case may be, to be an essential component of more efficient healthcare and quite frankly higher quality healthcare when you look at what is available to make better decision making.”
That approach to managing information, the wide community involvement and the fact that Capital Health is a long-term Oracle customer in Canada earned the organization its recently announced position as one of four founding members of a North American and European advisory group for Oracle. The group is providing site-testing and guidance as Oracle develops and implements a web-native, patient-centric healthcare information system. Oracle claims the system, scheduled for beta implementations in autumn 2002, will consolidate clinical, administrative and financial objects and business rules across an organization.
Ian Fish, Oracle’s national industry directory for healthcare, reports that Oracle sought a company in Canada because, from a healthcare perspective, Canada is more like the rest of the world than is the U.S.
He says Capital Health was chosen because it had already adopted Oracle technology and applications, had a regional, community healthcare focus as opposed to a hospital base, and is regarded within the Canadian market as being a leader in community healthcare.
“The solution we’re actually developing is based on the concept of interoperability across not only different applications but different applications across all different modalities of care,” says Fish. “We’re focused on hospitals as well as community health to provide true operability.
“Canada has a much more consolidated approach to healthcare and this consolidated approach is a very good fit with Oracle’s new focus on interoperability within healthcare,” he adds.
He notes that shorter patient stays in hospitals make following up with patients – “outcome analysis” – very difficult because “outcomes” are actually happening in the community. Oracle’s new system proposes to create an infrastructure that includes different segments of healthcare providers to be able to answer questions such as: what happens to a patient after he/she is discharged following hospital treatment or intervention?
“Because of the focus on interoperability, obviously security and privacy are very important components,” Fish continues. “We’re taking advantage of what’s inherently within the Oracle technology but also building specific functionality that is required for healthcare – to meet healthcare legislation whether it is in the United States or Canada. We want Edmonton to help advise us on what are some of the unique security and privacy requirements for the Canadian market.”
Single patient views
Providing one view of one person as opposed to multiple disjointed views will be a challenge given that healthcare goes beyond physicians and hospitals right into the community to include physiotherapists and allied health professionals such as speech pathologists, chiropractors, massage therapists and many others, as Fish points out. It even touches the educational system, the criminal justice system and the justice system itself, he says
And that raises security and privacy concerns – which Strating believes are better addressed by “having information framed in an electronic basis versus the current system today, which has always been in existence, which are your paper charts.”
She cites the ability to create and monitor an audit trail as one of the advantages. “In the electronic system, every time somebody logs in and touches a piece of information an audit trail is built. There is no (audit trail) in paper. Someone can take the chart, but we have no idea, once the chart leaves the medical records room, where that chart may go and how many nurses look at it.”
Paper records can be faxed to a wrong number or sent by courier to a wrong address. She says the electronic authorization and the authentication process provides a safer “one-to-one information highway.”
Another benefit is the ease of encrypting data “so that we don’t have the ability for someone to interrupt the information flow and figure out exactly everything that is going on with someone.
“There is no back up to paper medical records,” she continues. “Data redundancy is there (in the electronic world) that if for some reason a fire or whatever occurred, your health record is not lost in the process.
Increasing patient control
“Another thing that I think is key for patients and is an impossible task to do with paper record is that in the future as we start building information exchange with patients themselves, they are going to have the ability to mask their data,” she adds. She explains that in the electronic environment, a patient can make some choices about who and what types of people can see what part of their medical records.
“I think there is a lot to be gained in terms of improved security of information with looking at electronic data sharing,” Strating summarizes. However, she is also quick to admit to challenges that must be overcome.
These include the ability by some to hack into the electronic world and the fact that a single mistaken distribution of data can reach a very broad base.
“In the paper world it is very difficult to send 100,000 charts to the wrong spot,” she admits.
Another challenge to electronic health records is dealing with the privacy legislation in Canada which defines who can see what kinds of information and varies from province to province.
“If I even want to share your information with somebody in Toronto because you’ve got in a car accident, I can’t necessarily do that, because I have a set of rules here in Alberta which may be inconsistent with the rules that exist in another province,” she explains. “So, those types of things will create barriers to look at as we figure out how we sort through the roll out of electronic information.
“Many provinces have adopted legislation very specific to electronic health information and Alberta is one of those,” she adds. “I can fax it, I can mail it but I cannot send it in electronic exchange mode now with the same parameters as I can fax anything else. There is a lot of that going on in the U.S. now too.”
Building consumer confidence
The move to electronic healthcare records is clearly being met with concern in many quarters. Strating compares it to the building of consumer confidence to bank online or use a credit card to order online.
“I think people’s fears are because you can aggregate so much information in an electronic single location and because accessibility is so much easier if you talk about the portability of it,” she suggests. “I think where consumers are concerned is it makes it too easy to start doing things with it. You can start to analyse it, you can share it — and where is the control around that? Whereas I think that maybe people have a comfort – it may be a false comfort but it has been there forever – that a paper record has a much more limited environment, as to what they can do (with it).”
She sees devices for authenticating who looks at information as critical in ensuring privacy controls are in place. “Some of the things that are coming out now — whether they are done by thumbprint or things that allow you at the terminal to walk away immediately the record will go down — those are important. It is very easy to have something laying out there or very visible when someone leaves for two minutes to say ‘oh, no big deal.’ We’re looking at a couple (of security devices) here, where you put them around your neck and you walk up (to your terminal) and it turns it on and activates it, and you walk away and it brings it down. Those kinds of devices are important because they enhance the security of the information.”
Once those security concerns are met, the electronic information system becomes a critical component of getting the right information to the care provider such as who the person is and what care has been given, Strating says. She takes what she refers to as a “longitudinal view” where one can apply IS to provide a patient-centered umbrella of information for a person that enables their information to be seen by caregivers in home care, acute care, by a family physician and wherever appropriate.
If Oracle heeds her feedback as they fine-tune their new healthcare information system, she may have the opportunity to bring such an IS capability to reality.