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We'll close this trilogy with a discussion on whether Dr. J's requirements are realistic or otherwise; let's review them:

·         a connection to every hospital in Ontario (explicitly for her LHIN)

·         a Software as a Service (SaaS)/web-based EMR application

·         a reorganization of the way patient/operating data is managed in Ontario

The PRHC Improvement Plan (PIP) update was an agenda item at the July 20^th, 2010 CE LHIN Board meeting, and the discussion that ensued is also pertinent.

I was very encouraged by a comment from Ken Tremblay (hospital President/CEO) – he posited that healthcare has gone from a service to a knowledge industry.

I instinctively looked around the room as if I'd be able to tell from the various expressions, those who really understood the profundity of that statement.

Mr. Tremblay went on to suggest that healthcare has become very complex and his hospital needed not only to attract the best specialists in the various medical fields, but the infrastructure must also be in place for them to share information.

There's nothing being requested here that's beyond the capability of current technology, so one of the key enablers is quite possibly data management.

The visions put forward both by Dr. J and the PIP have me thinking: 

·         what if LHINs were to implement the “grocery store” model of data management by taking physical ownership of, and centralizing their respective patient/operating data? Authorized access to this repository would be via web-based tools. For example, Loblaws operates under many store banners in Ontario; I would confidently wager that the company has the technology in place to instantly determine the profitability of a bunch of bananas I recently purchased at my local grocery store – without such tools it would be difficult for it to remain viable in the long term; imagine all LHIN Corporate offices being in a similar position to determine the financial health of any/all of their institutions in real time!

·         What if LHINs were to encourage all primary healthcare providers operating within their respective jurisdictions to use the aforementioned repositories via a web-based EMR application? This could be reinforced with a program similar to that currently being implemented in the US

·         what if LHINs were able to mine their respective patient data repositories to ascertain any disease trends and act proactively to minimize the impact on local residents?

·         what if LHINs were able to offer local residents access to their personal health data via applications such as the TELUS Health Space PHR, in a bid to positively impact wait times and other initiatives?

·         what if LHINS were interconnected so that the mobility of Ontario residents' patient data or the sharing of summarized data was a secure and seamless process?

In spite of the fact that the above musings are evolutionary in nature and are by no means all-encompassing, action needs to be taken sooner than later.

A CMA poll has indicated that Ontario residents/Canadians are really concerned about the future of our healthcare system. As Anne Doig M.D. (outgoing president) states:

“It's true if we do nothing, then there will be a major crisis coming at us – we have the opportunity to […] prevent it from becoming a crisis."

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Let's continue our discourse around Dr. J's “must-haves”, with the second item, a SaaS or web-based EMR system.

As a bit of a backgrounder, we'll travel back in time to her university days – you see, web-based E-mail was unav ailable and the only way to get access during her travels, was to dial-up the school's facilities; this more often than not turned out to be prohibitively expensive.

I'm sure you can imagine her parents' delight when Hotmail was introduced – no more phone cards or long distance charges to be concerned with – no more “sorry, the mail service is currently unavailable due to maintenance” messages for Dr. J; now, all she had to do was find an Internet-enabled computer system to reliably keep in touch with friends and family.

Fast forward to the year 2010; Dr. J has a thriving paper-based neurosurgery practice in Ontario, Canada, and is actively investigating the implementation of an EMR system to more efficiently serve her patients.

She's sat through numerous meetings with the governing body for her practice, faithfully attended the annual AAN conferences, and had passionate discussions with her peers; at almost all of these events, EMR systems was one of the hot button topics.

However, what she's found so far in her research, has not been encouraging – not that there's anything inherently flawed with the functionality of the current recommendations from OntarioMD; basically she'd rather not be tethered to any of them.

Changing to EMR technology is disruptive enough without the added responsibility for system troubleshooting, data security, privacy issues, maintenance and the like; sure, she realizes she can hire someone, but what Dr. J would really love to see is something similar to web mail whereby she can sit next to any of her patients anywhere (be it at her practice, hospital bedside etc.) with her iPad and discuss their case via a browser-based application.

Dr. J currently outsources the maintenance of her vehicle, her financial record-keeping, building maintenance and security, web mail etc. – what makes an EMR application any different? In fact, why can't she just outsource it to her LHIN organization?

She realizes that healthcare in this province is moving to the stage whereby health providers will be held to a standard of “results-based” care; being distracted by the complexity of maintaining Information Technology systems or any other tool in her healthcare toolbox for that matter, is no longer an option – applying all her efforts (to keeping current with the latest developments in her field and helping her patients stay healthy with tools such as the TELUS PHR offering), is.

Next time we'll discuss the third and final point, namely the way patient data is managed in Ontario – let's see if we can put Dr. J's ideas together into one cohesive plan from a ten thousand-foot level perspective.

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I can't help wondering why doctors in my area still use paper-based systems; in spite of well-documented/discussed efficiencies afforded by an Electronic Medical Record (EMR) system, available subsidies from the OntarioMD organization etc., the status quo is being maintained.

Instead of adopting a critical stance, I've decided to try and place my feet in their shoes, so to speak, via a fictional character called “Dr. J”, so here goes... Plus...