Health care not yet ready to share
(From the Globe and Mail - Friday, June 10, 2011)
An industry struggles to loosen control of record storage in order to improve communication and cut costs
DIANE JERMYN
Special to The Globe and Mail
Health care providers could benefit from putting their heads in the clouds - the computing clouds, that is. But many in the field do not appear willing to do it.
"The technology is there but the politics aren't necessarily ready nationally," says Brantz Myers, director of health care business development for Cisco Systems Canada. "The players and the people in the health system have their own local agendas in many cases, and are really making it a challenge."
If Canadian hospitals and health providers moved to cloud-based services, they could relieve themselves of managing and maintaining their own computing infrastructure and, in turn, offer better access to health information and improve sharing of patient records between institutions, Mr. Myers says.
Some local and regional institutions are threatened by the cloud, Mr. Myers says. But he says some regional health-information services in Ontario, which already support up to 15 hospitals, may eventually evolve into a cloud service for the entire province.
The installation of cloud systems would not result in the wholesale elimination of hospital IT staff, as some have feared, he says. As technology becomes more efficient, however, some people and their jobs are at risk. That's where the cost savings lie - in eliminating redundant, non-scalable, non-interoperable work. Any reallocation of resources could be used to bolster patient care, he points out.
"The real shift is moving them from the server room to the client side," he says. "In the past, we'd have a nursing station with a few computers at it and now we're moving to potentially multiple devices per person in the health system. And that includes the patient."
It's clear something needs to change. After years of talk, no single, co-ordinated information system has emerged to serve the country, let alone each province, that allows electronic patient records to be shared. Experts have noted that the savings such a system would create could be redirected into, say, shorter wait times for knee replacements. Yet progress has been slow.
Consider this scenario: You have an expensive diagnostic test in Toronto. Then you travel to another province, or even a different part of Ontario, and suffer a heart attack.
The doctor examining you likely won't be able to access your critical medical information because the hospitals' electronic patient record systems are incompatible. So that diagnostic test you had may be unnecessarily repeated - that is, if you're not already dead.
A lot of the problem boils down to "interoperability" between systems at myriad institutions, says Oliver Tsai, director of information technology at Sunnybrook Health Sciences Centre in Toronto.
Sunnybrook has developed its own cloud-based software, called MyChart. Patients can access, and choose to share, all their personal health information stored on MyChart, using any kind of device with Internet capability.
So, if you're a Sunnybrook patient and conscious in emergency, you can fire up your iPhone and share your last ECG test with the medical team.
"We're working with other hospitals to co-ordinate information from multiple electronic patient records into a single MyChart," says Mr. Tsai. "That's the big challenge. It could bring health care costs down enormously because co-ordinating access to test results could significantly reduce duplication."
While the challenges of interoperability continue to stymie the health care world, security is another big issue. Not all health organizations like the idea of sharing in a cloud.
Mr. Tsai says Sunnybrook's system uses the same security technology that the banks use. "Our privacy office went to a great deal of work ensuring that access was compliant with both provincial and hospital policies," he says.
Jim Forbes, chief technology officer at Toronto's University Health Network, an umbrella organization of three major hospitals, believes cloud computing offers value to the health system. But he's waiting for some legal clarity and looking for more vendors to be operating within Canada. NHN isn't using cloud computing. The fact that most major cloud services are being offered out of the U.S., that's a worry for him.
"There's a lot of nervousness about storing data in the United States because of the Patriot Act," says Mr. Forbes. "Our main concern is privacy, partly because of sharing with other people and partly because the Patriot Act gives the U.S. government authority to have access to records if they're stored on American soil."
What UHN would like to see is a private federal or provincial government cloud that provides a shared resource for health applications and information that is offered only to health care customers.
So far, no one has done that.
Mr. Tsai believes that Ontario, through its ehealth Ontario initiative, is trying to move in that direction, but it's a complex process. "Progress is slow but steady, and very challenging," says Mr. Tsai. "If you look west to British Columbia, Alberta and Manitoba, they're already seeing strides toward co-ordinating these electronic patient records between different institutions."
Cisco's Mr. Myers says that if each province built a private cloud, "we might still have interoperability challenges across those 10 clouds. But inside each one of those clouds, we'd go a long way toward solving the challenge of being able to move from one part of a province to another with shared access to electronic medical records."
Mr. Myers predicts we will likely see real health clouds within 18 to 24 months.
"There's a bit of a shift with younger doctors coming into the health system," says Mr. Myers.
"They're more used to a shared world through social networking. As those concepts make their way into the workplace, the politics will slowly go away."
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