Health informatics is a multidisciplinary area which covers medicine, technology and people. The area puts an emphasis on implementation of information technology and computer science to health care to better manage it. E-health or electronic healthcare is a relatively new discipline introduced to improve patient care, shorten delay times, and prevent errors in clinical settings. Electronic health record (EHR) is an electronic record of patient’s medical history which includes but is not limited to medications, X-rays, allergies, immunizations etc often accessed by authorized personnel (doctors, nurses and pharmacists) at hospitals and clinics. This will replace paper and eliminate the need for manual paperwork which is unreliable and tedious. According to International Journal of Medical Informatics V. 78, “By 2041, 22% of the Canadian population is expected to be aged 65 or over, up from 13% in 2001” (The Change Foundation, 2005). As the elderly population start to retire, the cost and demand of healthcare increases drastically. This also increases the risks of diseases with aging such as type two diabetes, cardiovascular disease, different types of cancer, arthritis, Alzheimer’s disease and more. Thusly, new and efficient systems are needed for this to better handle this trend. EHR is necessary to fulfill the gaps between health supply and demand, it will benefit patients, health care personnel and improve health care system overall.
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There are both benefits and barriers to EHR; fortunately, there are ways to overcome the barriers and implement EHR in Canada. The main benefit of EHR for patients include the general improvement for quality of care by providing detailed information about patient’s medicine intake and history, consequently preventing errors in the future. Other benefits include the mobility of records from medical institutions, hence helping those in remote areas. There would also be fewer waiting times in emergency rooms and clinics since medical personnel have instant access to patient’s record. EHR also benefits healthcare providers and workers by reducing time spent on paperwork and increasing productivity; while providing efficient and comprehensive care to the patients. In spite of this, some critical barriers do prevent it from adoption. The major concern is privacy of patient’s records and security. Privacy is a very significant issue and individuals want their information to be in safe hands. Other barriers include initial setup costs and training for new technologies. Overcoming these barriers will require time and incentives both from public and government which will be discussed later. In conclusion, implementing electronic health records in Canada and overcoming the barriers will benefit patients, healthcare personnel and improve the healthcare system overall.
Background
New technology has benefited humans to a great extent and EHR is certainly no exception. EHR has existed in Canada for a while but it is still not fully acknowledged by the public. There are television commercials from Canada Health Infoway promoting and raising awareness of EHR in Ontario and British Colombia. The Canadian government has dedicated $1.6 billion to Health Infoway whose objective is to implement a pan-Canadian EHR and provide records to all Canadians by 2015. Alberta has already launched a successful system called “Netcare” which lets physicians, hospitals and pharmacists’ access secured online system and observe patient’s health information. Netcare is one of the reasons why Alberta has the most efficient and best health care system in Canada.
On the other hand, Ontario has recently suffered from an appalling scandal which resulted into an estimated $1 billion wasted. “eHealth Ontario has come under criticism as well. In April 2009, the province’s opposition parties argued that the government wasted $647 million developing electronic health records before they shut down the SSHA only to start again from scratch with eHealth Ontario” (CBC News, 2009). The Health ministry of Ontario needs to take responsibility, stop wasting taxpayer’s money and implement this system which is long overdue. Other countries have already introduced EHR, such as United Kingdom, Australia, the Netherlands and New Zealand. Canada and United States are still debating adoption and falling behind. Majority of the countries which have implemented EHR have national health insurance system which is funded through taxes, similar to Canada. Yet Canada is trailing behind due to ethical and political barriers. It is disappointing to some extent that Canada as a developed nation still lags behind other countries in health care advancements. Nonetheless, these barriers can be solved through increased funding, incentives and establishment of secure systems.
How does EHR benefit patients and health care workers?
Physicians will benefit greatly from EHR, according to the International Journal of Medical Informatics V. 76 “A recent survey of U.S. primary care physician found that almost 75% indicated that these applications could reduce errors; 70% perceived IT as potentially increasing their productivity; over 60% indicated that IT tools have the potential to reduce costs and help patients assume more responsibility” (J.G. Anderson/E.A. Balas, 2006). EHR helps medical staff keep track of patient’s prescribed medicines, previous health conditions, allergies and chronic diseases. This ensures physicians are fully aware of situation and can provide proper treatment with smaller chances of making errors. “EHR provides access to current information at the point of care. It gives medical service providers access to key patient information along with online decision support and reference tools. It also helps reduce the possibility of medical errors, assists with compliance issues, and decreases the potential for adverse drug reactions. Features like lab value trends and drug monographs also help with patient consultations.” (Alberta Netcare, EHR). This benefits both physicians and patients.
For example, if someone has a minor or major accident and is rushed to an emergency room for medical attention, the doctor is required to question the patient for previous medication, history, allergies etc. It is difficult for a patient to recall their history in such a state and is generally unable to communicate. This wastes time and becomes more likely for the doctor to misdiagnosis. According to Health Infoway, “Right now in Canada, the lack of a comprehensive EHR system, for every 1,000: Hospital admissions, 75 people will suffer an adverse drug event; Patients with an ambulatory encounter, 20 will suffer a serious drug occurrence; Laboratory tests performed, up to 150 will be unnecessary; Emergency room visits, 320 patients will have an information gap, resulting in an average increased stay of 1.2 hours” (Strasbourg, Health Infoway). If EHR were present, the doctor would have had instant access to patient’s medication history, allergies thus avoiding unnecessary testing. Also, it would allow a quicker diagnosis with little or no mistakes. This will save great amount of time in emergency rooms therefore reducing lines and making health care system more efficient. Some hospitals in North America do possess EHR systems but it’s restricted to that specific institution. If EHR connections between hospitals and other medical institutions are established, it becomes easier for health care practitioners to assess patients and provide service. As a result, EHR allows medical professionals in remote areas to access information using network and vice versa. In conclusion, there are some major benefits to EHR which could provide assistance to Canada’s healthcare system and improve quality of care.
What are the barriers and risks?
There are some significant barriers which prevent EHR from implementing in Ontario and other provinces. The main and most controversial barrier is privacy and security of patient’s health record. EHRs contain very personal important information about a patient which includes demographics, prescribed medicines, allergies, immunizations, lab tests, X-rays and other reports. It would be devastating and very dangerous if records fall into the wrong hands and/or are mistreated. There has been an incident where a patient’s privacy was not respected. “A guilty plea and hefty fine for unauthorized access to personal health information sets a very important precedent for health care providers, says Information and Privacy Commissioner Frank Work. A medical office clerk from Calgary pleaded guilty to charges of improperly accessing another person’s medical information, in contravention of the Health Information Act (HIA). The individual appeared in Calgary court Friday and was fined $10,000. This is the first time that charges have laid under the HIA.” (Office of the Information and Privacy Commissioner of Alberta, 2007) This creates fear in the minds of the public and privacy and security is at stake despite laws and regulations. These incidents are rare but they do expose the lack of privacy and vulnerability of EHR to disloyal employees. There are also claims that EHR’s access to internet and broad systems make it vulnerable to hackers.
Figure 1 shows different factors which affect the objective of implementation. (International journal of medical informatics V28)
Another barrier to EHR is the initial setup costs and hiring/training staff for new technologies. Developing integrated organizations can be costly and require years before efficiencies are realized. Information technology supports integrated care as EHR allows physicians to access patient information through centralized network (Mary E. Wiktorowicz, p. 301). This can be very expensive because governments have to establish centralized system to store, protect and handle records. As mentioned earlier, vast amount of funding ($1 billion) for eHealth has already been wasted in Ontario and it will be more difficult for taxpayers to reimburse this especially during these harsh economic times. Great incentive and financial support is needed from public to accomplish this venture. All paper records have to be transformed into electronic which will be very time consuming. In conclusion, there are some significant barriers which hinder the implementation of EHR.
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Overcoming barriers
As mentioned already, there are existing laws which already protect the privacy of Canadians. EHR must obey The Privacy Act whose purpose is to extend the present laws of Canada that protect the privacy of individuals with respect to personal information about themselves held by a government institution and that provide individuals with a right of access to that information (Privacy Act 1985, c. P-21). The Government of Canada and medical institution have a responsibility of protecting and insuring the security of medical records. Alberta has also introduced Health Information Act (HIA) which setup guidelines for both patients and health care workers. This act requires workers (authorized) to access files only when necessary and in professional manner. So far there has only been one situation which set a precedent and sent a serious message to all health care custodians and their employees. “This is a very serious matter, and health care providers must know that surfing records for personal purposes will not be tolerated and individuals will be prosecuted” (Wayne Wood, 2007). Medical personnel that violate policy and law are held criminally responsible and their jobs are taken away immediately. Thus it would not be wise for any staff to commit such actions which would cost them their jobs, salary or even end up in jail.
EHR are still more secure than ordinary paper records. For example, “in November 2008 a reporter of RTV West, a local Dutch radio network, asked for a copy of medical records in several hospitals and asked to fax them to his home. He easily got six out of eight requests without any questions. In the two other cases the hospitals solely requested a written permission (i.e. a signature)” (Laurens J. van Baardewijk, Amsterdam Law Forum). This exposes the weak and unsecure system of paper records. Fax machines, telephone and mail systems are very unreliable. There have been numerous incidents involving paper medical records either used improperly by clinical staff or stolen by an intruder and used for unlawful purposes. This is due to lack of security and reliability of traditional paper records. On the other hand, EHR requires login information from health care professionals and authorization is required from patient and worker. All EHR systems are encrypted and only accessible to authorized users (doctors, nurses, health care workers). Encryption is established into multiple layers which require multiple login sessions and online security monitoring. This makes it extremely difficult for hackers to access the system; consequently, EHR system is both safe and secure. Initial costs are very high and taxes have to increased once again to successful establish this system.
An EHR system in Ontario does not necessarily have to cost a fortune, because they could simply borrow and emulate the system from other provinces such as Alberta. McMaster University has already developed a beta system for EHR in hospitals but Ministry of Health is not paying close attention. Nonetheless, EHR system will be established very soon throughout Canada and once it’s established, it’ll decrease medical costs by $6 billion. This will eventually decrease the amount of taxes issued significantly, especially in Ontario. It will also create new jobs in health informatics field and provide training to nurses and doctors. It is estimated around 40,000 new jobs will be created. The benefits of EHR are far greater than the risks and barriers. EHR will certainly benefit Canadians and improve our health care system.
Conclusion
EHR has benefits, barriers and risks, but it is now evident that the benefits outweigh the risks. EHR will be available to all Canadians soon in the future despite the barriers because as population increases, diseases increases and senior citizen population increases accordingly. Therefore, demand for health care rises as more people are waiting in lines for hospitals and clinics. Comprehensive and efficient EHR systems are very crucial to meet health demands of citizens. Some key benefits include the improvement of quality of care by providing information about history consequently preventing errors in the future. Other benefits include the mobility of records from medical institutions and reducing waiting times in emergency rooms and clinics since medical personnel have instant access to patient’s record. It also benefits health care providers and workers by reducing time spent on paperwork and increasing productivity while providing efficient and comprehensive care to the public. Privacy and security issues still remain; nonetheless, they will be resolved with new laws and technological improvements. Initial setup will be expensive but EHR’s benefits are vital to Canada’s health care system. Canada needs to catch up to other developed countries in health informatics and improve health care system. To conclude, implementing EHR in Canada will benefit patients, health care personnel and improve health care system overall.
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