Government & policy
Experts calling for a national, e-health
OTTAWA – In
response to a recent World Health Organization (WHO) report that ranks
Canada’s progress in e-health as 21st among global nations, healthcare
leaders are calling for a new body to assess, track and monitor
healthcare I.T. efforts across the country. They also say that new
policies are needed to spur faster development of electronic solutions
in the healthcare sector.
Canada’s progress in the development of a national electronic health
record system has been “very slow” and “pretty incomplete”, agreed Dr.
Brian Postl (pictured).
In an article in the Canadian Medical Association Journal (CMAJ), Dr.
Postl, dean of medicine at the University of Manitoba in Winnipeg and
chair of the Canadian Institute for Health Information, asserted that a
new organization is needed to monitor Canada’s e-health activities.
“From an accountability perspective, the public should have some
awareness that we’re not as far along as we would like to be or as they
think we are.”
Louis Barré, CIHI vice-president of strategy, planning and outreach said
that Canada must adopt new and better measures to track and assess
national e-health efforts. This would help ensure that national
investments in e-health properly address “the real paucity of clinical
systems” that currently exist. He said greater efforts must be made to
ensure that electronic systems are applied to medical research, as well
as to the clinical sector.
Postl and Barré would like to see an independent body created that would
assess and report on government efforts – perhaps with arms’ length
assistance and funding from a federal agency or department such as CIHI,
the Canadian Institutes of Health Research (CIHR) or the Health Council
There’s a need for better tracking and monitoring of e-health by
analysts independent of government, concurs Dominic Covvey, president of
the National Institutes of Health Informatics (NIHI), a Canada-wide
network of 151 e-health researchers who collaborate within a “virtual
institute of institutes.”
Canada needs an e-health “watchdog,” says Covvey, who notes that Canada
Health Infoway, the federal e-health agency, faces growing criticism for
strategies that have left the nation trailing other nations in e-health
development, despite years of planning and some $4 billion in federal
and provincial spending.
“Infoway has no evaluation mandate,” Covvey adds, charging that any
evaluation of e-health performance that occurs within Canada Health
Infoway amounts to little more than “government evaluating itself.”
Robyn Tamblyn, health informatics researcher at McGill University in
Montreal, Quebec and leader of a CIHR-funded team that investigates the
use of e-health technologies to support integrated care for chronic
disease, says the recent WHO snapshot suggests that a much closer look
at Canada’s e-health policies and progress is now warranted.
By providing impartial information, a current state assessment will
allow policymakers to substantiate official claims, Tamblyn argues. A
thorough assessment will also help steer e-health development toward
patient-centered solutions and foster such innovation, she argues.
“Policies are needed to support research and translation of local
successful initiatives [within] a ‘bottom-up’ approach.”
“To avoid unnecessary political wrangling,” Tamblyn recommends the
effort be conducted under the rubric of the CIHR in order to achieve
“objective, systematic collection of empirical information.”
The calls for an independent assessment of Canada’s e-health efforts
follow in the wake of a WHO report that ranked Canada 21st in terms of
information technology progress among 159 nations – just ahead of
Estonia, but well behind much of Scandinavia, Europe, and the Republic
of Korea (http://www.who.int/goe/publications/goe_atlas_2010.pdf).
The report, Atlas: e-health Country Profiles, concludes that Canada’s
e-health deficiencies include a lack of supportive federal laws and
regulations, national procurement and technology policies, educational
policies and scholarships, and evaluations to monitor progress on
important areas such as the capacity to deliver health information to
patients via mobile telephones.
The WHO profile indicates the time has come for a much more detailed
review of Canada’s e-health status, he adds. Canadians are often
“stunned” to discover that basic health information technologies are
unavailable, Postl argues. “The public thinks that much more exists than
actually does exist.”
“Do we know what is happening? The answer is no,” says Barré. “A current
state assessment would be very helpful.”
Tamblyn argues that Canada also needs to develop an ambitious new basket
of national policies to galvanize e-health progress. The policies should
facilitate timely clinical information-sharing between providers in all
settings, make personal health records and self-management tools
accessible, enable reimbursement for e-visits, enable interdisciplinary
teamwork and provider consultation, establish incentives for using
electronic reminders for preventive care and personalized healthcare,
and implement patient outcome-based financial incentives, she says.
David Thomas, spokesman for Health Canada, said “the timing of the WHO
survey in 2009 coincided with advance planning for H1N1, a public health
priority in Canada, so unfortunately not all of the provinces and
territories were able to provide input to the Survey. In addition, as
with any survey, there are limitations, which include the interpretation
and applicability of the questions.”
Thomas also noted that “e-health applications were difficult to assess,
and the responses provided may not apply equally across the country.”
Posted January 27, 2011