Tag Archives: Digitizing Healthcare

Public Awareness – A Timely Investment

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

86% of Businesses Still Using Paper-based Forms

Many analysts, consultants, and industry pundits (myself included) are fond of pointing out the extent to which the health sector lags other industries with respect to the use and adoption of information technology.  Given this common perspective, I was intrigued to read about a recent survey sponsored by Anoto, a company which developed and sells a digital pen that converts handwritten text into digital form.

According to Anoto’s research,”86% of businesses are still using paper-based forms in either their own business or in their clients’ business”.  If Anoto’s data is anywhere close to accurate, it appears that other industries are suffering from similar challenges to the health sector in digitizing business processes.  Other interesting survey results include:

  • “45% said the use of paper-based forms over the last five years has either increased or stayed the same”
  • “38% said they are planning to incorporate new solutions, particularly the iPad, into their business processes for data capture”

Even though I am somewhat leery of vendor surveys as they often have a bias towards the company’s products, I thought that the seemingly high dependence on paper forms was worth mentioning and mirrors my experience with many companies with whom I deal.


Digitizing Healthcare – Don’t Forget Usability

One of the topics that seems to getting more attention as we strive to push health IT more into the mainstream is usability.  Prior to fully immersing myself in the health sector seven years ago, I worked for a major Canadian system integrator and had an internal usability team reporting to me.  This team joined the company through the acquisition of a small but innovative Canadian Internet consulting company and we struggled at times to demonstrate its value to the rest of the organization.  In working with this team to figure out how best to sell their services to our clients, I learned a lot about usability and the importance of taking usability into account during the design stage.

I came across what I think is a succinct summary of why usability is so important to the health sector.  Of particular interest in this article is the table listing five  “usability myths” and corresponding “usability facts”.   One of myth in particular resonated with me – “Usability is entirely a matter of subjective opinion”.  As the article points out, this rather commonly held view is completely false and there are indeed a variety of criteria that can be applied to assess usability.

I believe that one of the greatest challenges that we have to realizing the full benefits of digitizing our health system is usability.  As the article points out, a report published by the National Research Council (“Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions“) points out that ““…the nationwide deployment of health IT will not be sufficient to achieve the vision of 21st century healthcare, and may even set back the cause…. [Success] will require greater emphasis on providing cognitive support for healthcare providers.”  Failure to address cognitive usability is a very real possibility, one that must be addressed more aggressively in my view.