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Government & policy

Review calls for accelerated EHR action in Saskatchewan

REGINA – 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 healthcare system.

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 London, Ont.

The Patients First review based its findings on the input of 4,000 Saskatchewan citizens and hundreds of caregivers and healthcare administrators.

“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 month.

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 requirements; and
• 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 practices.”

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 Métis citizens.

• 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