Government & policy
Review calls for accelerated EHR action in
Saskatchewan needs an integrated system of electronic health records to
boost the quality of care received by patients, and to reduce medical
error and wait times, concludes a new review of the provincial
The need for better use of electronic records is one of the major
recommendations of the Patients First review, headed by Tony Dagnone
(pictured), former president of the Royal University Hospital in
Saskatoon and former CEO of the London Health Sciences Centre, in
The Patients First review based its findings on the input of 4,000
Saskatchewan citizens and hundreds of caregivers and healthcare
“Information technology is a prerequisite to improving patient care and
safety, reducing costly duplication and delays, and supporting increased
accountability,” says the report, which Dagnone delivered earlier this
The review recommends “that the Ministry of Health, in consultation with
the health regions, the cancer agency, and clinical leaders invest in
and accelerate development of provincial information technology
capabilities within a provincial framework. This will involve:
• Developing an e-Health implementation plan by early 2010;
• Securing and stabilizing funding for both the provincial electronic
health record requirements and health region implementation
• Determining the preferred service delivery structure for IT at the
health region level to ensure the realization of one provincial system.
According to the report, healthcare in Saskatchewan “remains largely
paper-based, with most practitioners writing diagnostic and therapy
orders and maintaining manual records which cannot be readily
transferred from one part of the health system to another. Yet the
highly complex nature of health care demands greater access to
information through technology.”
It goes on to say that, “Numerous patients have multiple, redundant
patient records scattered among several healthcare facilities.
Saskatchewan patients repeatedly provided examples of misplaced,
unavailable, or scattered health information and consequent errors,
adverse events and duplication of costly and/or painful tests and
procedures. Accessible patient information is vital to improving service
integration and coordinating patient care.”
The review also stated that Saskatchewan’s healthcare system is
currently structured around care providers while it should be making
patients and their families the focus. To this end, the review calls for
a patient’s bill of rights and responsibilities.
As well, it notes that medical records are often difficult for patients
themselves to access, and are often regarded as the property of the
care-givers. This practice should be changed, writes the commissioner.
“I strongly suggest that the Information and Privacy Commissioner be
involved in formulating policy regarding appropriate access to health
records. When almost every other industry in the developed world is
utilizing technology to make information more readily accessible to its
customers, we can expect that patients will soon demand easy and
immediate access to their own health care records. Patients expect to be
better informed about their health conditions and treatments.
However, the changes being called for will not be so easily implemented,
as the commissioner himself observed: “Cultural change will be very
difficult to bring about. A system’s culture does not change very
easily,” said Dagnone. “It requires strong, sustained creative
leadership and a common vision that brings people together. It requires
hard work and extra effort by all involved to change longstanding
Health Minister Don McMorris said the first step is recognizing that the
problem exists. “An attitude shift or a cultural shift – it’s really
difficult to measure. But it’s small steps along the way and I think
we’ve already started down that process.”
Dagnone said change is vital, describing Saskatchewan’s current health
system as one where residents pay high costs for services that do not
appear to offer high value. “Rather, the system struggles to meet demand
and maintain basic safety and accessibility standards while often
failing to adopt practices that ensure high quality. And for those whose
experiences in the system are not positive, the consequences can be
profoundly upsetting – even dire,” his report says.
The review also recommends:
• That the health system develop and implement a province-wide chronic
disease management strategy that ensures patients receive
evidence-based, standardized care, wherever they live, and connects
patients with multidisciplinary health care teams.
• That the health system develop a comprehensive and innovative strategy
for rural and remote service delivery.
• That the health system take immediate action to improve Saskatchewan
patients’ surgical experiences, from initial diagnosis through to
recovery, through an aggressive, multi-year, system-wide strategy that
is reported to the public with clear targets and regular updates.
• That the health system address inappropriate usage of emergency rooms
by exploring the applicability of urban urgent care centres. The
appropriate health regions should explore alternate financing
partnerships in developing these projects, which incorporate state of
the art design and leading technologies.
On this front, Dagnone suggested that alternative solutions could be
supported – such as private diagnostic clinics that augment the public
system and reduce wait times.
• That the health system, in collaboration with First Nations and Métis
Elders, and patient and family advisors, work to develop a culturally
safe and competent health system that better serves First Nations and
• That the Ministry of Health achieve greater value for patients’ tax
dollars by establishing a provincial shared-services organization that
would gain buying power and realize significant savings. This
organization would initially be responsible for supply chain management
(competitive tendering, procurement, storing, distribution, and
payment), with the subsequent addition of responsibility for health
regions’ transactional business functions.
Posted October 22, 2009