Nero (37 AD to 68 AD) is notoriously known as the Emperor who “Fiddled while Rome burned”. While this idiom is recognized to be erroneous — the fiddle was only invented in the 16th century — it signifies “doing something trivial and irresponsible in the midst of an emergency”.
As I look over the past 10 years of Health IT (EMR, EHR, Infostructure, etc.) in Canada, my observations are as follows:
- The establishment of Canada Health Infoway in 2001 signalled a decade of investment in modernization of Canada’s health information infrastructure. This was an exciting time. Over a period of 10 years, $2.1 Billion has been provided to Canada Health Infoway to support Health IT investments with various percentages of matched funding from the provinces.
- In the early stages of this investment cycle, a fairy-tale sense of inflated expectations accompanied a great deal of activity in most provinces, with attendance at national eHealth conferences and a feeling that great things were about to be achieved.
- Similarly, EMR programs were in various early stages of development in Ontario, Alberta, and British Columbia and overall EMR adoption by physicians started to increase. Nationally, though, the numbers were still small because of the piecemeal nature of EMR adoption strategies. In comparison to the rest of the developed world, Canada lagged and continues to lag behind other countries (2009 Commonwealth Fund International Health Policy Survey).
- Over this time frame, perception of the EHR and eHealth programs changed. eHealth scandals, criticisms of the Infoway and provincial IT strategies in a number of auditor general’s reports, and a general sense of disillusionment began to creep in.
- Glaring gaps in Canada’s health IT strategies became apparent, including a lack of attention of end-user adoption of technology by clinicians and absent or minimal leadership in relation to EMR-to-EMR interoperability, E-Prescribing and data standards for Electronic Medical Records.
- Attempts to remedy these gaps at the clinician level resulted in development of a Canda Health Infoway EMR certification program in 2011 (see Infoway EMR Certification — Too Little, Too Late?).
- Provincal adoption of EMRs continues to languish (see 2010 National Physician Survey) and a number of established EMR programs are stuck around the 50% mark in terms of adoption of EMRs by physicians.
Last week, the National Health Service (NHS) in the UK announced cancellation of their National Program for IT (NPfIT), which demonstrated some success but was not felt to be deliverable based upon performance to date. $9.9 billion has been spent on this program so far. When a national program of this size fails, one has to ask questions regarding the viability of any national IT strategy. Have the right questions been asked? Are we focusing investment in the most beneficial areas? What are the barriers to successful acceleration of national strategies?
I have not heard a blip about the NHS failure in Canada. How can we be successful with the Health IT agenda without widespread end-user adoption of technology? What is being done to fix the problem of standards for EMRs, vendor viability, and nationally accepted standard messages for E-Prescribing and E-Referral? More importantly, how can we do this without meaningful debate about the national program and strategies to fix the broken components?
The announcement by Canada Health Infoway of the ImagineNation Challenges is a great idea and the organizations who have supported this strategy should all be commended for thinking outside of the box. What I would also like to see is a transition challenge. Once winners are selected, we need strategies to support the conversion of ideas into widespread clinical practice. The innovative idea is easy in comparison to actually deploying a concept and having it widely accepted.
We should not fool ourselves into believing that it is OK to come up with the ideas and then the job is done. In 2005/2006 I participated in a $3 million primary care strategy as a member of a regional team of physicians, clinical architects, IT staff, and project managers. We built clinician engagement strategies, system navigation tools, privacy education programs, and components of the regional EHR viewer. Some survived, but the majority did not. This was a valuable lesson in understanding how difficult it is to transition great ideas from concept to use to widespread adoption.
Some may believe the bulk of work has been done. In reality, it is only beginning.
Do you agree or disagree with my positions and statements? Add your thoughts by clicking on the “Comments” link below.