number of initiatives aim to create computerized network of patient
Special to The Globe and Mail
July 30, 1999 A 78-year-old man recently hobbled into
an Edmonton emergency ward suffering from acute stomach pains.
He told a doctor
he'd been constipated for 10 days, but a physical examination revealed
no cause. Nor could the patient remember taking any drugs that would
have caused the problem. Normally, the doctor's next step would
have been to subject the man to a painful and invasive probe to
look for colon obstructions. Instead, this doctor found what he
was looking for on his computer.
With only a
few keystrokes, the doctor was able to view the drug record of his
elderly patient under a pilot program run by the provincial agency
alberta wellnet, which gives two Edmonton hospitals electronic access
to the records of all prescription drugs purchased by seniors under
the Alberta Blue Cross benefit plan. With that information, the
doctor was able to see that the man had taken a painkiller with
side effects that were causing the problem -- a painkiller he had
forgotten to mention to the doctor.
wellnet project is one of a growing number of initiatives aimed
at creating a shared network of electronic patient records -- allowing
any medical practitioner anywhere to gain access to lab tests, medical
histories, hospital charts, diagnostic procedures, drug records
and any other medical information from pharmacies, labs, doctors'
offices, clinics, hospitals and other medical facilities.
By going electronic,
this information will be available instantly by computer networks
and secure Internet connections at the desktop or mobile computer
of any medical practitioner who needs to see them. The federal government
and an advisory team of medical experts expect these electronic
records will eventually be available for every patient and at every
medical facility in the country. The federal Health Ministry has
committed $328-million toward various initiatives to help realize
that goal. Many provincial health ministries, regional health authorities
and hospital networks have already built their own networks for
exchanging electronic records. These include alberta wellnet, which
links the province's 17 newly created regional health authorities;
several initiatives in British Columbia, including a network that
lets all pharmacies in the province share prescription records;
and a plan in Quebec that will make it possible to access any information
on an individual patient through a chip embedded on a smart health
For Tom Noseworthy,
electronic medical records are a major medical breakthrough that
will transform Canada's healthcare system.
potentially life-saving," says Dr. Noseworthy, a professor
and chairman of public health science at the University of Alberta
and co-chair of the federal advisory council on health infostructure.
a network is an enormous task for a complex and fragmented health
system strapped for cash and facing enormous problems of confidentiality
and security of patient information. In many hospitals and doctors'
offices, patient records are still kept on paper. But this creates
a problem in an era of restructured healthcare services, where patients
may go to one hospital for emergencies, to another for heart surgery
and to a third for follow-up. Provincial governments, regional health
authorities and amalgamated hospital corporations therefore have
been scrambling in recent years to create computerized patient records
that can be sent electronically from one department to the next
and from one institution to another. But each of these small networks
has grown in isolation, many using proprietary technologies that
do not talk to one another. Now, service providers such as Markham,
Ont.-based IBM Canada Ltd. are creating middleware applications
that bridge the gap and link disparate systems.
the newly created electronic Child Health Network (eCHN) connects
Toronto's Hospital for Sick Children with four other facilities,
each with its own proprietary system. With doctors able to use the
electronic network to share information, more children can be treated
closer to home instead of going to Sick Kids for consultation, says
pediatrician Alan Goldbloom, the hospital's vice-president of academic
and clinical development. "They only come to us for the most
acute and most complex things."
from Oracle Corp. of Redwood Shores, Calif., is helping a network
of public health authorities in British Columbia provide electronic
access to children's immunization records and to keep track of communicable
diseases to give early warnings of potential outbreaks. Layton Engwer,
director of information management at the B.C. Centre for Disease
Control, says the electronic records are replacing vaccination cards
that were kept by children and their parents. These would often
get lost, with the result that some kids got immunized more than
once and others did not get immunized at all.
chief executive officer of Toronto-based HealthLink Clinical Data
Network Corp., predicts that improvements in handheld computing
and the increasing capacity of wireless networks are about to precipitate
a boom in the use of electronic health information, because it will
mean that clinicians will be able to consult electronic records
at the bedside and in hospital wards without having to find a desktop
computer. For example, wireless technology developed by Toronto-based
Autros Hospital Systems Inc. has automated the dispensing of drugs
at Toronto's West Park Hospital, where nurses carry handheld devices
that scan identification codes on patients' bracelets, exchange
information with a central database in the hospital pharmacy and
send signals to a mobile trolley to release the correct dose for
are making it easier to extend health-information networks to doctors'
offices and community agencies. For example, doctors in the area
of Markham-Stouffville Hospital are using Calgary-based Clinicare
Corp.'s recently released WebCPR software to share records over
the Internet and view lab results and images such as X-rays on an
ordinary desktop computer.
in British Columbia are doing something similar, with the help of
database technology from Ottawa-based Mainsource Software Corp.
Chris Skinner, vice-president of healthcare business development
at Mainsource and a neurologist at Ottawa Hospital, says the database
creates an index of all the records about each of these doctors'
patients, which may be located in computer systems in various institutions.
All the information remains in its original location, but the software
can find, retrieve and send copies of any relevant data whenever
an authorized clinician makes a request.
Forces are using Mainsource technology to create an electronic database
of the health records of more than 60,000 personnel. This project
will be particularly complicated because it will mean gaining access
to the records of civilian hospitals in every province, says Lieutenant-Colonel
Jim Kirkland, the officer in charge of health-information management
and communications. But he sees enormous benefits. When a Canadian
soldier in Bosnia has heart palpitations, for example, military-base
medical staff able to check his electronic records on-line will
know whether the soldier has a minor condition or one requiring
immediate removal to hospital.
communications make it possible to study old X-rays or view recent
test results almost instantaneously, the technology is changing
the nature of patient records, says Deborah Del Duca, executive
director of the Canadian Health Record Association. Instead of being
just a historical chart, it becomes "a living, breathing database
of what is happening now."
as electronic health records can be, many patients may be reluctant
to have an insurance company, an employer or even close relatives
have access to such information. That is why security and confidentiality
are the most sensitive issues -- and potentially the greatest barriers
-- in creating a nationwide electronic health-data network.
cannot make systems secure and ensure confidentiality, we cannot
proceed," says Tom Noseworthy, co-chair of the federal advisory
council on health infostructure.
This is not
just a matter of making sure that personal information is kept secure
by means of encryption technologies. It also means agreeing on policies
about who should have access to what information when, and making
sure patients have control over how their personal information is
used, he says.Jim Norton, chairman of the Canadian Managed Care
Council and senior vice-president of health strategies at Toronto-based
Aon Consulting Inc., says many doctors are worried about the way
health information is used in the United States, where the practices
and results of individual physicians are often compared on the basis
of information gleaned from electronic records.
see the U.S. situation, where various groups publish report cards
on doctors with regard to how they treat patients and what drugs
they prescribe, and they fear that type of thing," Mr. Norton
can actually make it easier to control who uses the information
and in what circumstances by setting up rules for access to data
so that each person within the healthcare system receives only the
amount of information that he or she requires for the job at hand,
says Sharon Baker, chief executive officer of Toronto-based HealthLink
Clinical Data Network Corp., which connects more than 40 healthcare
organizations in Ontario. Legislation and policies governing privacy
and confidentiality are being evolved at a provincial level. Because
each province has differing priorities and needs, the challenge
of getting everyone on the same page is enormous, says Shelagh Maloney,
director of information management at the Canadian Institute of
Health Information, the body entrusted with co-ordinating these
side is the easy piece compared to making sure that there are policies
in place to guide the application of technology," Ms. Maloney
says. "Each province and region has different requirements,
but there needs to be a base standard to which we all adhere."
confidential information into the hands of physicians and keeping
it confidential, a national health-information network should be
able to strip personal details away from health data to present
it in an anonymous format that can be used for research, Ms. Maloney
making decisions on the management and restructuring of the health
system. It is important to be able to make these decisions on the
basis of good information."