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Government & policy

Manitoba review calls for enhanced e-Health

WINNIPEG – An external review of Manitoba’s regional health authority (RHA) system has recommended the province significantly increase its commitment to e-Health, electronic health records and telehealth.

Manitoba Health Minister Theresa Oswald (pictured) released the final report of the external review of the regional health authorities in mid-February. The review was launched by the minister and the Regional Health Authorities in April 2007 to assess the regional health authority system and make recommendations for improving patient services.

“I would like to thank the reviewers for preparing this report,” said Oswald. “They brought their collective experience in front-line healthcare, business and hospital management to this task.” To advise on the report’s 35 recommendations, Oswald will establish a regionalization working group chaired by the deputy minister of health.

The full report from the review committee is available online at

On the e-Health front, the review committee had four major recommendations:

• The Government of Manitoba should make a public commitment to health-service related information and communication technologies, commit itself to the appropriate level of funding and ensure that its information and communication technologies initiative has effective project management.

• Manitoba Health and Healthy Living should contract with an external consulting group to conduct an annual risk review on the progress being made in the implementation of the Manitoba e-Health strategy. This would reduce the chances of project failure, according to the committee.

• Manitoba Health and Healthy Living should take steps to accelerate the implementation of clinical telemedicine throughout Manitoba to enable efficient and effective care close to home to make regionalization function more effectively.

• Manitoba Health and Healthy Living and the Winnipeg Regional Health Authority should ultimately include all Regional Health Authorities in establishing shared business information and communications technologies solutions to provide transaction based services for human resources, financial accounting and supply management.

Interestingly, the report claims the Manitoba government and its health regions have made e-Health a low priority in their funding of capital projects. As a result, e-Health in Manitoba is at a less advanced state than in other provinces.

According to the report, “During the period 2000/01 to 2004/05, Manitoba RHAs, in total, spent at a rate of about 1% of their operating budgets on ICT. Ontario and Alberta spent approximately 2.5% of their operating budgets on ICT during this period and Nova Scotia, New Brunswick and British Columbia spent over 2% in the later years of this period. The difference between 1% and 2.5% of the Manitoba RHA operating budgets in current dollars is approximately $40 million each year.”

“As a result of minimal spending on ICT, Manitoba RHAs, overall, have very limited computerization and a large backlog of needs for investment in ICT. Alberta has the most advanced ICT capabilities of any province in Canada. In 2008, approximately 50% of primary care physicians in Alberta will have electronic access to laboratory, radiology and drug information on their patients, up from approximately 33% in 2007. This compares to less than 10% in Manitoba. Alberta has been so successful because the Premier of Alberta publicly announced that ICT was a provincial priority many years ago, there has been a continuing high level of investment in ICT in that province over a period of about 10 years and there has been effective project management.”

Electronic health records

The Manitoba report noted that, “Electronic health records are an essential part of modern health-services delivery… Electronic health records are necessary to achieve the benefits of regionalization. Integration of care across the continuum is a key goal of regionalization and cannot be effectively accomplished without the implementation of electronic health records.”

“The Brandon RHA has invested in electronic health records over the years and its work should be considered an example of a best practice. The Brandon Hospital system allows staff to register patients in all acute care settings, place doctors’ orders, view test results and chart information electronically. Moreover, two major clinics in the Brandon RHA have their computer systems linked to the hospital system, allowing doctors to receive information on patient test results electronically.”

“Historically, Manitoba Health and Healthy Living has assessed RHA requests for funding of ICT projects on a case-by-case basis. During the 2007/2008 planning cycle, Manitoba Health and Healthy Living established a centralized process for planning and funding ICT projects following a five-year plan that is called the eHealth ICT Roadmap. When the initiatives that would need to be undertaken over the five-year period and the resources necessary to carry them out were defined, it was concluded that the resource requirements of the defined initiatives surpass the availability of resources both in terms of money and skilled people to do the work.”

“Manitoba’s eHealth strategy will require sufficient funding and very effective project management to be successful. Manitoba will be competing with all of the other provinces for scarce ITC professionals at a time when all of the other provinces have made electronic health records a priority. As a result, attracting skilled staff to manage and carry out these projects will be a major challenge. Nevertheless, Manitoba Health and Healthy Living deserves credit for establishing an eHealth ICT Roadmap and a governance structure that prioritizes all clinical and non-clinical ICT needs in the province.”

“The Review Committee’s experience suggests that annual external risk management reviews of the implementation of ICT strategies can reduce the risk of implementation failure. These reviews can be used to provide an independent perspective on how well the ICT strategies are being carried out and what can be done to increase their likelihood of success. Given that Manitoba has such a large backlog of ICT work to be accomplished in such a short period of time, an annual external risk management analysis would be of considerable benefit in the Manitoba situation.”

Clinical telemedicine

MBTelehealth (MBT) was formed in 2001 to provide telehealth video conferencing throughout Manitoba. MBT has expanded from 8 to approximately 60 sites across Manitoba. Sixty per cent of sessions are for clinical purposes, 20% for education, 10% for administration and 5% for other purposes. Over 250 physicians from more than 25 clinical specialties use MBTelehealth. This means the service is used by only 15% of Manitoba specialists. A recent external review by a consultant suggests that the specialists currently using telehealth in Manitoba are early adopters (people that like to try new ways of doing their work) and that it will require specific strategies to get large numbers of other specialists to accept telehealth as an effective means of providing care.”

The consultant’s report also notes that the current fee schedule in Manitoba for family physicians acts as a barrier to telehealth use, since family
physicians are not eligible for payment for consultations with a client via telehealth unless they are assisting a specialist.

Another factor limiting service expansion is the lack of reliable high-speed network access to First Nations and other remote communities. Resources for telehealth are also limited and stretched quite thinly. The consultant’s report states that, while service volumes have increased by 300%, MBT has not received any increases in funding beyond the cost of living since 2003.

Telehealth can provide major benefits to a province such as Manitoba, including reduced patient travel time and improved access to health services in the community, reduced cost of accessing care and enhanced ability to support inter-disciplinary care in remote communities. The Review Committee’s discussions with the representatives of the RHAs indicate that there is great, unmet demand for the expansion of telehealth services. Some RHAs have very little telehealth service, while others, such as the Norman RHA, have made very good use of telehealth services. The Norman RHA best practice has telehealth at all three of its acute care sites and plans to expand it to community sites. Telehealth is used in the Norman RHA to link family physicians with consultants primarily for surgery, dermatology, oncology and mental health.

Shared business ICT solutions

Prior to regionalization each hospital and facility had its own ICT systems for human resources, financial accounting and supply management. Since the beginning of regionalization, all RHAs have pursued shared business ICT solutions for these functions within their own region. The least progress was made in Winnipeg, where there has been limited common implementation of these systems across sites.

Recently the WRHA undertook a business process solutions project to look at ways to standardize and integrate the aging business processes and technologies for human resources, financial accounting and supply management across the region. The estimated cost of replacing systems was considered to be prohibitive and it would have to compete with all other capital expenditures under the capital ceiling for health. As a result, a request for proposals was issued to identify a proponent willing to provide the capital for upgrading these systems.

Based on experience in other locations, such as in Toronto, the Review Committee believes that shared business ICT solutions are a sound strategy for providing transaction-based services for human resources, accounting and supply management.

Given that Manitoba is a small province in terms of population, it should be possible to extend the WRHA initiative ultimately to all RHAs with a single service provider. This should generate direct savings through more efficient processing functions. In addition, this will enable the creation of both a common human resources database that can be used for more effective human resources planning and a common supply management database that can be used for more effective joint purchasing.