We marvel in what our society can do with computers. We can book an airplane, choose our seats, print our tickets and reserve a rental car and a hotel at our destination.
By comparison, health care seems relatively backwards but in truth much of the problem is due to the much greater complexity of health care. An airline flight is the same every time but each patient with a heart attack will follow a somewhat different course.
To try to understand the situation, we can start with Dr. Ben Carter. He embraces the idea of changing to an electronic office and is willing to purchase the necessary software.
He interviews reps from different companies but is uncertain just what he needs. A colleague tells him to make sure that his system can talk to Health Records at the hospital, both the private and hospital labs and imaging departments, the pharmacies, MSP for billing, a source of treatment protocols, etc. Each company has strengths and weaknesses and he makes an educated guess.
Now he and the patient are in the room, what does he do? He actually did take typing but has noticed after a number of patients that neither he nor they are that happy that he is looking at the screen and typing away vigorously all the while they are talking.
He can’t afford to hire a scribe to sit there entering data when he already needs to employ a nurse/receptionist. He ends up scribbling mini-notes after the patient leaves that he can enter on the computer later. He has tried a voice-activated dictation program but there were enough errors that he had to check everything and correct lots of typos.
Dr. Ben is now seeing Shirley, who is new to him. If he were Shirley’s GP he could instantly obtain her medical record from Royal Inland but since he has no previous association with her he is blocked electronically.
Even if he could get through, he could obtain only the record of events that have occurred since digital data entry began relatively recently. To view events of 10 years ago he has to go to the hospital and read the chart.
His system can’t talk with her previous GP’s computer so he has to have Shirley sign a records release form and have it mailed or delivered to her doctor for action, which might take a week or more if he/she is very busy or away.
He prescribes a medication for Shirley and enters it in her new chart. The computer will warn him if the dosage is wrong or there is a potential interaction of concern with one of her other meds, at least most of the time.
Pharmanet is still working out the problems of interoperability and confidentiality so he cannot send in the prescription electronically and must fax it in or give her a written prescription.
Ordering lab tests and medical imaging studies is smooth by comparison but is definitely easier for specialists than GPs for anything out of the ordinary.
Let’s look at the larger picture. We need information systems at various levels. The U.S. has passed the HITECH Act which creates a bureaucracy to develop a common language that all health-related software companies must use to allow inter-communication.
Nationwide electronic prescribing, health knowledge sharing, and quality reporting are all mandated.
Canada has its Canada Health Infoway to develop national and interprovincial information exchange but with the Harper government trying to shift health care to the provinces it likely will be only a shadow of the U.S. program.
Make no mistake about how difficult this is. After spending nine years and $17.8 billion US, the U.K. has decided to jettison its attempt at a national system in favour of smaller regional districts.
In B.C. we have the eHealth program that will try and get the whole province on the same electronic track. Interior Health is the first health authority to try and get all its hospitals operating on the same company’s system. Coastal Health has gone the route of picking the best company for each area of need — the best pharmacy program, the best records program, etc. and then trying to get them to link.
We are only in the early implementation phase but there are already vast areas of improvement. Once it is completed we can work out the bugs and continually refine the system. It will take years and billions of dollars but the final product will be awesome.
Dr. Russ Reid is a retired Kamloops physician.