Dr. Roger Stronell gets IT.
He sees the power of information technology in health care. He continually seeks ways to use IT to improve patient service delivery and enhance the productivity of doctors at his clinics.
That’s a refreshing attitude in a professional community where aging legacy computing systems and disparate applications that don’t easily exchange information are the norm. From an IT perspective, hospitals and health care centres in most of Canada operate in information isolation – a problem that often limits both the quality of patient care and the efficiency of doctors.
Dr. Stronell is director of imaging services for the Kitchener Area Reproductive Medicine Associates (KARMA) clinic, part of a group of community health care facilities located in Kitchener, Mississauga, Oakville and Toronto. The Kitchener clinic is staffed by approximately 20 employees, including doctors, nurses, and clerical and laboratory professionals.
IT started to make a difference at the KARMA clinic in Kitchener in 1996, beginning with the integration of various separate information databases. Dr. Stronell worked with a technical team to develop a single database for all information gathered at the clinic, and eventually a network communication system that allowed doctors to more easily access and share patient information.
“In the beginning, like most doctors I knew nothing about personal computing and computing in general,” he recalls. But his example shows how people with vision can drive important technology-related changes, and KARMA has become a model for ways the health care system could be improved on a larger scale across the country through IT.
Back in 1990, Dr. Stronell was managing a number of diagnostic radiation clinics in southern Ontario. As fate would have it, he was in Toronto at a teleconferenced speech given by Andy Grove, the CEO of microprocessor giant Intel Corp. It was there that Dr. Stronell was struck by an epiphany.
“It occurred to me that having a doctor in one place and sending images to him for diagnosis from another place made a lot of sense,” he says.
But making that idea a reality wasn’t simple. It’s one thing to have videoconferencing interaction, but something else entirely to track the other things that can occur in a patient-doctor setting. Dr. Stronell reasoned that while networking made sense, it wasn’t much good unless the communication system tied everything together into a single database.
The videoconferencing demonstration set Dr. Stronell down a path of IT evangelism.
“I started looking at health care databases,” he says. “Most of these I [had] found to be proprietary and limited in their use. You had laboratory, pathology and radiology databases, and these worked well in what they did, but didn’t communicate with each other.”
Dr. Stronell explains that a patient might provide information in one location of a clinic or hospital and then have to repeat that procedure at a different clinical department or on another hospital floor. The IT systems used for various information gathering tasks or processes might use different technology and applications that did not share data. He realized that a common repository of information that could be shared would provide tremendous efficiency and let doctors do more than ever.
In 1996, KARMA was like most health care centres and hospitals, relying on handwritten documents on paper for information capture. In the clinic’s second year of existence, Dr. Stronell and a technical team “networked” the central database, which became a collective repository for all of the imaging data, health care reports and laboratory tests performed by the clinic.
“We then introduced scheduling and billing [systems] that ran off the same database,” he says. “It was a multimedia, relational database in a health care setting.”
A document management application was introduced in 2000, providing the means to scan forms and store these in the commonly shared database. This allowed physicians to look at medical reports from other doctors, “from wherever they wanted, whenever they wanted.”
Tablet PCs – portable laptop-like electronic pallets for handwritten information – were introduced to the KARMA clinic setting a couple of years later. The tablets allow physicians and nurses to log patient care and other information on the spot and directly into the clinic database through a wireless connection.
“As much as staff were reluctant at first, they now prefer tablet PCs to the handwritten chart,” Dr. Stronell says.
These examples might not seem remarkable in a business setting, but they’re rocket science compared to the way much of the current health care system operates.
What Dr. Stronell has learned from his experiences is that reluctance and apprehension are the bane of IT adoption in Canadian health care environments, describing the task of linking health care information systems as monumental. This is further complicated by the fact that doctors tend to be conservative people, Dr. Stronell says, pointing out that the information they gather about patients is important and highly guarded. The vast majority of Ontario doctors – he estimates 95 per cent – still don’t use computers to manage their data. Instead, handwritten medical records remain stored in file cabinets across the province.
Past experience has also created a lack of confidence in IT for some physicians and health care clinics. Many have been “burned” as a result of buying systems that were not able to handle the job, Dr. Stronell says.
Even so, he remains a true believer in the benefits of modern information technology to the Canadian health care system, and actively seeks opportunities to introduce IT-enabled applications and processes. His latest plan involves a whole new way for KARMA to log patient medical prescriptions. The clinic will soon make it possible for doctors to write a script from a tablet PC, print it out as a patient medical prescription and electronically log a copy of that prescription into the same common database as other patient information. The prescription can be sent by wireless connection directly to a chosen pharmacy, where it may be printed and also kept as a permanent record.
When it comes to adoption of technology, Dr. Stronell estimates the Ontario health care community is 20 years behind a vertical industry such as financial services. He believes, however, that IT can and will do for health care what it’s done for banking and other private sector businesses. As KARMA shows, technology is a potential cure for current inefficiency and, ultimately, better health care services in Canada.