After reading my blog post on Canada Health Infoway’s planned public advocacy campaign, Michael Power, a respected colleague and cherished friend tweeted a comment that I felt I could not adequately address in a 140 character reply. In what I now fear might have a knee-jerk reaction to defend my opinion, I challenged Michael, a lawyer by profession (which means that he argues for a living), to a public debate conducted on our respective blogs. As my mother always warned me, be careful for what you wish for, you might actually get it!
In his blog post response, my esteemed colleague attempts portrays spending on a public awareness campaign as a waste of money. He cleverly attempts to put words in the Auditor General’s mouth by musing whether the she would “consider such a campaign (with television advertising) a good ‘value-for-money’ exercise” and argues that “benefits should be self-evident because hundreds of millions have already been expended over the last decade”.
In this era of financial restraint and a recent history of eHealth scandals, Mr. Power’s arguments are, on the surface, quite compelling. Indeed, my initial reaction to Infoway’s plans was very similar Mr. Power’s reaction. However, upon further reflection, I have come to the conclusion that time is right for the type of public awareness campaign that Infoway envisions. If we are going to spend limited public dollars on digitizing our healthcare system, we (those of us advocating continued investment in healthcare IT) owe it to the public to explain why we feel such an investment makes sense and offer a compelling vision for how a digitized healthcare system will improve healthcare outcomes.
According to the federal Auditor General’s report that Michael Power referred to in his blog post, Canada Health Infoway was created to “lead the national development of electronic health record“, with the stated goal to “ensure that, by 2010, every province and territory and the populations they serve will benefit from new health information systems that will help transform their health care system“.
As a national leader, Infoway should ( a word that my wife frequently reminds me to use with great care) take a leading role in raising awareness among the main beneficiaries of a digitized healthcare system – the citizens who ultimately pay for and make use of the services that our healthcare system provides. While Mr. Powers contends that “public reports” be restricted to Infoway’s web site and annual reports, I assert that the Auditor General’s recommendation that “the Corporation should further explain in its public reports what is meant by having an electronic health record available to authorized health care professionals” can be interpreted in a broader sense to include a variety of communication tools including advertising and social media. Public reporting need not be limited to an annual report that few people will read.
A recent report by the eHealth Initiative – an independent, non-profit organization whose mission is to drive improvement in the quality, safety, and efficiency of healthcare through information and information technology – states that two-thirds of stakeholders reviewing the progress in health information technology and health information exchange initiatives in the U.S. believe that “outreach to consumers about the value of EHRs and HIE is not effective“. While similar data is not available for the Canadian market, I believe that the situation is likely the same in Canada. Doing more of the same, a course of action that Mr. Power seems to recommend, will not achieve different results and is, in my view, an ineffective use of limited resources.
Canada Health Infoway’s public awareness campaign is designed to explain the benefits of a digitized healthcare system in terms that everyone can understand through media to which most people are exposed. Sorry, Michael, but I don’t think that many people are going to go out of their way to visit the Infoway web site or take the time to read the Infoway annual report. More importantly, perhaps, I don’t think that we should expect them to do so.
Without using terms like “electronic health record” or “drug information system” or “Picture Archiving and Communication Systems”, the Infoway public awareness campaign uses simple vignettes that powerfully convey how a digitized healthcare system will make personal health information readily available when and where it is needed. Equally important, this campaign dramatically portrays the limitations of the current paper-based systems and the corresponding impact on patient safety that these limitations impose.
Educating the public on the benefits of a digitized healthcare systems is, in my view, clearly part Infoway’s mandate and is one mechanism that Infoway can use to drive greater interest in and significant adoption of various electronic healthcare systems. Unlike Mr. Power, I do not believe that the benefits are “self-evident”. How can the public be expected to understand what many of never seen before? Only when the public believes that timely and complete information is an integral part of the diagnosis and treatment process will they support (and perhaps even demand) continued investment in healthcare IT.
The Infoway public awareness campaign simply yet dramatically illustrates how lack of information can delay or even impede vital healthcare interventions. The various elements of the campaign will, I believe, leave people wondering why the same technology that they see used in other industries isn’t readily available to the professionals in whose hands they place their health and, in some cases, their lives. If the Infoway campaign can get Canadians to take a greater interest in the manner in which healthcare is delivered in this country and get them thinking about the challenges of delivering care with information recorded on pieces of paper, it will have delivered considerable value for the money invested in this campaign.
PS – After this blog post was initially published Infoway sent the following data point from their most recent public opinion survey:
Infoway Public Opinion Chart