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Personal Reflections - Insights into eHealth and EMRs

Posted Oct 30 2008 3:21pm

This is the first in a series of intermittent postings on eHealth and EMRs. Over the past year, I have had an opportunity to work in projects and participate in discussions at many levels within the healthcare system. This has provided an opportunity to gain insights that I would like to share through CanadianEMR.

Last week I attended the eHealth 2008 Conference held in Vancouver. Entitled 'Extending the Reach' what struck me most about the conference was the response to the physician track, a series of presentations that were accredited for continuing education credits by the College of Family Physicians of Canada. Even though there were only approximately 65 physicians registered at the conference (out of a total of 1700 attendees), these sessions were very well attended by IT designers, clinical analysts and those who run the business of healthcare within regions and government. The response to these presentations and the discussion that ensued confirmed how hungry the designers and developers are for clinical interaction and experiences at the rock-face of healthcare. My experience in healthcare IT to date confirms that although all the evidence points to a need for clinician engagement iteratively throughout project design and deployment, this does not take place often enough. Clinician engagement still seems to be something that takes place through a few focus groups at the beginning of a project and intermittently and peripherally throughout the development, but it is not sufficient. An entertaining and insightful presentation was given by Richard Granger who participated in an international panel and talked about his experiences as director-general of the NHS National Program for IT. One of the most interesting comments he made was about the 'lack of operability' of the inter-operability solutions that were delivered in the UK. The IT solutions did not deliver what was intended or required. Even if these solutions met requirements on paper or according to specifications, they did not, in many cases, deliver what was required from a business or clinical perspective.

Next week, I will be attending the WES Conference in Orlando, Florida. This conference is put on by Research in Motion, makers of the Blackberry. There are a few healthcare specific presentations, however what I will be looking for are insights into mobile and wireless computing and how these tools and lessons can be applied to healthcare. More in a future posting on CanadianEMR.

The following week is turning out to be very interesting. I will be in Toronto to participate in an expert discussion panel put on by the Conference Board of Canada and to present a document that I prepared for the discussion panel that will look at physician productivity in terms of the impact of Information and Communications Technologies. This should provide some interesting discussion and I will also report back on some of my insights as related to this topic.

What is becoming clearer to me as I spend more time in healthcare IT is the 'unmasking effect' of implementing technology in health regions, government or physician practices. The process of developing these projects results in a need to bring people together and look carefully at traditional roles and processes in the healthcare system that have in many cases not been analyzed for a very long time. This need to shine a bright light tends to expose inefficient processes and highlights the need to look for innovative ways to dig ourselves out of situations that appear to be running out of control. Take for example Canada's current focus on 'Wait Times' to access surgery and specialist care. A great deal of money is being spent on developing programs to deal with the wait time issue. However, at a recent discussion relating to some work that I was doing relating to a chronic disease management project, we brought together a group of GPs and Specialists to discuss the shared care model. What came out of this discussion was a very interesting finding. Specialists are holding onto their patients longer than needed and were doing primary care management for some of the more complex patients because they were not comfortable sending them back to the GP/FP for ongoing management. This tended to have nothing to do with the skills of the primary care physician to manage the patient and everything to do with a concern that items being requested by the specialists in their detailed consult letters were not being actioned by the GP practices. Why this was taking place was in most cases not the fault of the GP. A patient may have been instructed to follow up with the GP before seeing the specialist again, but had not done so. As a result, the patient returned to the specialist without certain tests or investigations being done. There are probably a multitude of reasons, but the bottom line is that someone is dropping the ball and patients are falling through the cracks. What was most striking about the conversation was the fact that the specialists felt that they were holding onto approximately 10-20% of these patients much longer than necessary. Before we throw IT systems at the wait-list problem, should we not be getting GPs and Specialists together and discussing these problems in detail to see how we improve the process? If we could open up an additional 10% of capacity in access to specialists by simply dealing with underlying systemic problems, would that not be a valuable contribution to our wait list agenda?

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