Meaningful Health Care Renewal: It’s All About the Information

Guest blogger Mike Barron is President and Chief Executive Officer of the Newfoundland and Labrador Centre for Health Information. He also serves on the Board of COACH, Canada’s Health Informatics Association, as well as the Newfoundland and Labrador Centre for Applied Health Research.

I am an unapologetic proponent of the health system use of information agenda. The premise of this “movement” is that the health system needs better information not only for improved direct patient care and safety but also for overall management of the broader integrated health system. For those of us who have been around, the sustainability and in essence the survival of our Canadian health system has been an issue for many years. It is through improved information availability at every level that we identify and understand the challenges as well as take advantage of opportunities to improve the health care system and population health in Canada. Most importantly for the purposes of this blog, it is through the health system use of information that the Health Council of Canada can provide key decision makers and the public with results of efforts to date in improving the health system in Canada.

So much for the soap box (not really).

The phrase “health care renewal” has become synonymous with significant changes and improvements that have been undertaken over the last number of years in the current health delivery and support system. The Health Council of Canada’s Progress Report 2011:Health Care Renewal in Canada  provides a broad overview/report card of recent significant health care renewal initiatives in this country and for the most part paints a positive picture on the results. That is good news for everyone in the country. The report also provides an indication as to how far we as a country still need to go to meet the current and future health system challenge. There is a lot of information in this report folks, but it is worth the read.

Both as a taxpayer and in my role as a health system leader, I am comforted and pleased with some of the progress that has been made as a result of the focused priorities and investments of our federal/provincial/territorial leaders. Investments in providing more timely provision of services and the required supporting infrastructure and infostructure are increasingly showing resultant value even in these formative years of health care renewal (yes, we are still at the very early stages even after all of these years).

In Newfoundland and Labrador, we are well along the path of electronic health record (EHR) development. We are currently one quarter of the way through integrating our community pharmacies with the provincial drug information system and we have already experienced many instances of improved patient safety. Our province-wide DI/PACS system and telehealth initiatives have both received positive post-implementation benefits evaluations. All the more reason why we need additional national investment in the EHR. The EHR journey is very much still in its early stages in this country and comprehensive availability and adoption at the jurisdictional level have not yet been achieved. However, with the joint investments to date of Canada Health Infoway and the jurisdictions, progress has generally been admirable.

One of the most refreshing and underlying messages of the report is the identified need for more and better information to support priority setting and to evaluate investment decisions. Given the disproportionate amount of provincial budget expenditure that the health system receives (now over 50% of total in some cases and costs continue to grow) it is necessary that we measure the impacts of introduced changes and investments in focused areas of delivery in order to either validate further investment or to avoid an escalation of commitment that yields little or no value. That is what successful businesses do and this is what the health system needs to do in order to carry out evidence-informed health care renewal.

This is why we need to design systems and processes that not only provide more direct value but also provide information that allows large investment decisions to be made that will result in the maximum value to the health system and, of course, the patient. Make no mistake, this information need is not predicated on saving money but on ensuring that the available money and resources are directed to areas that will maximize their utility.

The primary driver of health system costs are the expectations and demands of the general public. As the report notes, sometimes our indicators can be misleading, for example not everyone on the MRI waiting list necessarily needs an MRI. The report also indicates that teletriage services can be an effective means of helping people realize that alternatives to the emergency room exist. It is also noted that little evidence exists to its actual efficacy. Ontario is currently running advertisements aimed at helping people decide the most appropriate place for presenting with their primary health care needs. Is it working? I hope someone is evaluating this initiative and shares the results.

From a purely professional and personal perspective, I would like to see increased focus on funding that will enable the sharing and implementation of best practices for health care delivery across the country. We need to take advantage of good lessons learned. I would also be in favour of a national awareness campaign that hopefully begins to change public expectations of what they deem as quality health care. Many citizens still do not feel that they are getting good health care unless they get referred to a specialist, get a timely MRI, or walk out of the physician’s office with a prescription in their hand.

It all still comes down to having quality information.

Let us hope our federal/provincial/territorial representatives continue to get accurate and meaningful information that allows them to continue the value-push for improved health system performance at the micro and macro levels. As discussions begin related to a new national health accord of some form, let us hope this information allows them to make the right decisions on behalf of us all. I look forward to the Health Council’s next report.