Progress in Canadian Health Care Depends on Integrated, Electronic Health (eHealth)

Guest blogger Dean Giustini, M.L.S, M.Ed., is the UBC Biomedical Branch Librarian at Vancouver General Hospital. The Library supports one of the largest medical programs in Canada. He teaches courses on health librarianship and social media at the School of Library, Archival and Information Studies. He blogs at the Search Principle blog.

Introduction

The Health Council of Canada’s Progress Report 2011: Health Care Renewal in Canada is a comprehensive look at Canada’s health care system at the federal, provincial and territorial levels in five areas:

1.      Waiting times for surgery & (some) medical services

2.      Telephone health-advice services in Canada

3.      Electronic health record systems

4.      Pharmaceutical costs, and coverage

5.      Health innovation — finding new ways to tackle persistent challenges — to aid sustainability of Canada’s publicly-funded health care 

Recently, the Health Council reported on Canada’s progress in wait times, primary care, electronic health records, drug coverage and generic drug costs and expressed optimism about our collective “...capacity to collect, interpret and use health information to improve services and patient safety...”.  All of these issues are of concern to Canadians. But as a medical librarian working at one of Canada’s largest tertiary care hospitals, I would like to focus on the importance of electronic health records (EHRs) for the future of our health care system and the importance of coupling evidence-based medical information with EHRs. 

Evidence is key in health

As a UBC medical librarian, I see firsthand how evidence-based medical information makes an obvious difference in patient care. At the frontlines of hospital medicine, electronic health records (EHRs) are just part of improving our ability to capture, analyze and apply information in the digital age. On a purely practical level, making patient records accessible online is about efficiency and tracking patients as they move through diagnostic services, pharmacy and primary.

Health librarians need to be a part of any single integrated health record system. For, while providing online access to patient charts is important, an EHR system is also key to the practice of evidence-based medicine in Canada. The Health Council and Canada Health Infoway should think about the expertise that medical librarians can bring to ensuring that the best medical evidence is integrated directly into EHRs in Canada. This, not surprisingly, is one of the goals of the Canadian Virtual Health Library / Bibliothèque virtuelle canadienne de la santé. All members of the health care team (yes, librarians also) must work together to ensure that information and expertise is shared.

Health care spending in Canada 

According to the Health Council, health care spending reached a high of $192 billion dollars in 2010. Health care costs now comprise 11.9% of our gross domestic product (GDP). Interestingly, as costs go up, an issue I hear often at Vancouver General Hospital is that hospital resources are not always channelled to where they are needed most. This is partly due to a lack of integration of patient information. A decade ago, the Kirby Commission reported that a cost-benefit analysis was impossible since most institutions had no ability to capture, record and manage health information. As a response, Canada Health Infoway was created, which has made considerable progress since 2001 in reducing adverse events, cutting costs and improving drug tracking. But considerable savings can still be made through more wholistic integration in EHRs. 

Health outcomes and efficiency 

Our inability to measure (in)efficiencies in Canadian health care is a problem. Provincial and territorial partners are not working together to monitor activities and track health outcomes as much as they should. In a 2010 poll taken by the Canadian Medical Association, 80% of Canadians worry that our problems are overloading the system. However, while not a panacea, EHRs provide doctors and nurses with new ways to monitor and manage assets that are available. Without adequate monitoring of services received in doctors’ offices and hospitals, we cannot address inequities or inefficiencies in meaningful way. Automation of patient records and the many sources of evidence in medicine is a critical way to the future. 

Pharmaceutical spending 

The fastest-growing area of health costs in Canada is drugs. The Canadian Institute of Health Information reports that from 1985 to 2009 the percentage share of drugs as part of total health expenditures has increased from 9.5% to 16.5% in Canada. In fact, the bill for pharmaceuticals is now $30 billion dollars per year; Canadians pay 40% more for drugs than any of the other G8 countries. By moving to a national pharmacare system we would save $10 billion dollars annually. This would permit better drug tracking, insurance coverage and costs associated with patient care. Moreover, drug trends could be more closely watched and needless prescribing avoided. In the last five years, for example, more than 900 new drugs have been approved in Canada and yet very few are systematically monitored. At the end of the day, Canadians are consuming more and more drugs but we have no evidence our health has improved. 

Social determinants of health 

In Progress Report 2011, the Health Council points to issues affecting Canada’s poor and socially-disadvantaged. Looking ahead, socioeconomic factors must be addressed if we are to improve the health of all Canadians. This is especially vital for Canadians living at or below the poverty line. Research shows that social determinants such as employment, home and work environments and social relationships have a major impact on health and well-being. Sadly, Canadians with low incomes are more likely to suffer from chronic conditions such as arthritis, diabetes and heart disease, or live with disabilities or mental health difficulties. Not surprisingly, Canadians with low incomes are twice as likely as those with higher incomes to use health services.
The promotion of health in Canada is a collective responsibility, and should be central to making progress. Governments must develop better poverty-reduction strategies and emphasize programs to assist the poor, underemployed and disadvantaged. With health providers, Canadians should also have access to the most reliable evidence-based information available – from my perspective as a medical librarian, this is absolutely key to managing our health care system (and our own well-being) into the future. 

References:

Canadian Institute for Health Information. Drug Expenditure in Canada 1985 to 2009. Ottawa, 2009. http://secure.cihi.ca/cihiweb/products/dex_1985_to_2009_e.pdf

Canadian Medical Association (CMA). Health Care Transformation in Canada: Change that Works, Care that Lasts. http://www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Advocacy/HCT/HCT-2010report_en.pdf

Canadian Medical Association (CMA). National Health Goals for Canada: A Review of Successes, Challenges and Opportunities for the Canadian Medical Association. Ottawa 2010.

Finances Québec. For a more efficient and better funded health-care system. http://www.budget.finances.gouv.qc.ca/Budget/2010-2011/en/documents/MoreEfficient.pdf

Mendelson Rachel. The Worst Run Industry in Canada: Health Care.  Canadian Business. April 8th, 2011. http://www.canadianbusiness.com/article/11248--the-worst-run-industry-in-canada-health-care


Key Words: Electronic Health Records, Health Promotion, Pharmaceuticals Management

Collaborative Renewal

Guest blogger Judith Shamian is president of the Canadian Nurses Association (CNA) and president and CEO of the Victorian Order of Nurses (VON). She is also a professor at the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto, a co-investigator with the Nursing Health Services Research Unit, and was the executive director of the Office of Nursing Policy at Health Canada for five years.

The Health Council of Canada’s latest progress report on health-care renewal in Canada is an excellent tool that showcases something we all want to know: What’s working well across the country, and what’s not? Knowing the answer is an important step in helping successful innovations spread more quickly to other jurisdictions.

The report also provides valuable insights on challenges common to all regions. Canada’s registered nurses believe that these shared obstacles can best be tackled through a comprehensive and sustained plan of attack that involves the strong collaboration of federal, provincial and territorial governments.

The report reveals: “Even where provinces and territories are pursuing similar broad goals, they are generally doing so independently of one another.” This is very telling, as it is symptomatic of the fragmented nature of Canada’s health system. The right kind of nationwide improvements could leverage the value of health care innovation much more effectively than piecemeal provincial and local approaches alone. Upcoming negotiations focusing on a new federal, provincial and territorial health accord represent a crucial window of opportunity to engage Canadians and the entire health care community in the renewal of our health system.

Take, for example, the adoption of electronic health records, where the report indicates steady but uneven progress across the country. How is it that Canada, a world leader in information technology, is still using an archaic mix of paper-based patient records and multiple stand-alone electronic information systems that are not compatible? Imagine the efficiency gains possible if you could go from a family practice office to the hospital and then to a rehab centre knowing that each care provider could access the exact same essential facts of your health history. This means you wouldn’t have to remember all the details and repeat yourself at every encounter. Health care providers would know, for example, about your allergies, whether your tetanus vaccination is up-to-date and what medications you have been prescribed – a significant contribution to your safety as a patient.

This is just one example of the benefits that a national approach to health system renewal can bring to health care in all the provinces and territories.

National collaboration on wait times is another. While good progress has been made in addressing wait times for certain procedures, registered nurses are working to further reduce and manage their effects on Canadians and the health system – across the continuum of care. See examples presented in a recent report from the Canadian Nurses Association (CNA), Registered Nurses: On the Front Lines of Wait Times – Moving Forward.

The progress report comes at an extremely opportune time, as several groups of health professionals are driving initiatives to accelerate collaborative action on health system renewal. In fact, the coming weeks will see CNA launch a national expert commission on health system improvement entitled The Health of Our Nation – The Future of Our Health System. Stay tuned for more details!

Key Words: Electronic Health Records, Access and Wait Times