According to a recent iHealthBeat article, Dr. David Blumenthal, the U.S. National Coordinator for Health IT, identified four barriers to health IT adoption in the US in a recent speech. These barriers include:
- A lack of adequate funds;
- Not having the necessary infrastructure to support the exchange of health information;
- Concerns among health care providers about what type of EHR system to purchase and whether it will become outdated; and
- The need to convince the general public that health information will be exchanged privately.
In the same speech, Dr. Blumenthal stated that many of these challenges will be full or partially addressed by the various initiatives driven by HITECH Act funding.
Does Canada face similar challenges to the US regarding adoption of health IT? Are our various funding programs (provincial EMR programs, Infoway programs, etc) addressing the Canadian challenges or are additional initiatives required?
At the itHealthcare Canada conference and exhibition organized by HIMSS Ontario earlier this month, one of the keynote speakers, Dr. Kevin Leonard, questioned whether we have the appropriate leadership in Canada to aggressively drive deployment and effective use of eHealth applications. While munching on some leftover turkey this weekend, I was catching up on various blogs that I read and came across a post on the eHealthCentral blog on that caused me to think about Kevin’s comments regarding eHealth leadership in Canada.
The eHealthCentral blog post mused about the current situation in Australia. Like Infoway in Canada, the National E-Health Transition Authority (NEHTA) in Australia attempting to coordinate eHealth deployment. The eHealthCentral blog post notes concerns that “NEHTA’s powers are to some extent limited by its structure, and by the fact that there are too many government instrumentalities that have a finger in the ehealth pie, and too many vested interests at work in the industry.” The blog post further explores the complex environment in Australia, noting that:
“At a national level you’ve got DOHA setting policy for the primary care sector. At the State and jurisdictional level you’ve got State governments setting their own priorities and policies for the hospital sector. You’ve got Medicare, which is a division of the Department of Human Services. If you were trying to bake a cake with those ingredients, you’d have a persistent problem of them separating out.”
Trisha Greenlagh, a noted commentator on the UK eHealth market, suggested to the eHealthCentral blog author that “Australian ehealth needed a publicly identified leader at the helm.” Ms. Greenlagh stated that “We don’t really want a formal leadership structure” but, rather, “de-centred” leadership with a clearly identified spokesperson who can “articulate what is going on.”. She suggests that “It wouldn’t necessarily be the big guy on the big salary who is in charge. It would be a little more subtle and de-centred, just like as in an ant colony, where there is no chief executive ant. I do think a lot of the leadership will be from clinicians.”
Given the many criticisms leveled at Canada Health Infoway, I do wonder if perhaps are expecting too much from one organization, particularly given its governance structure. As Trisha Greenlagh notes, there are substantial benefits to having a recognized spokesperson, like Dr. Blumenthal in the US, who can tell the eHealth story in a compelling manner that catalyzes action and rallies support across disparate stakeholder communities.
Yesterday I watched a media conference at which the US Dept of Health and Human Services (HHS) announced the final rules associated with “meaningful use”. Each of the five speakers used personal stories to illustrate the importance of electronic health records, starting with the HHS Secretary who related her experiences taking a friend to the emergency department and ending with an impassioned plea for patient access to their personal health information by a widow who literally fought with the healthcare system to get care for her dying husband. Three of the presenters were medical doctors who are now in positions of significant authority and had experienced the transition from paper to electronic records firsthand.
What struck me most about the media conference was that while each presenter’s arguments stood on their own merit, they all fit together in way that the whole was greater than the sum of the parts. There were clearly common themes that tied the presentations together, both in terms of the words that they used and the techniques they used to convey their message. One of the best collection of related presentations / speeches that I have witnessed in quite some time.
I encourage anyone who in some way or other is trying to convince others about the value of digitizing our healthcare system to watch the HHS presentation. It offers a good example of how the value of electronic records can be explained in simple terms and will leave you wondering how anyone might consider not moving forward aggressively to digitize our healthcare system.
One of the eHealth 2010 sessions that I looked forward to the most was a panel discussion with Dr. David Blumenthal, Director of the U.S. Office of the National Coordinator (ONC) for Health IT, and Mr. Richard Alvarez, President and CEO, Canada Health Infoway. Both gentlemen have challenging mandates and there is no shortage of “monday morning quarterbacks” analyzing their every decision and parsing their every word.
Alan Gregg, noted pollster and social commentator, moderated the session. For someone who professed to know very little about eHealth, he demonstrated an amazing grasp of the issues. Citing his own research, Mr. Greg offered the following observations:
- Physicians view themselves as independent operators.
- Physicians don’t want bureaucrats dictating what they do.
- Left to their own devices physicians will do nothing to promote EMR/EHR.
- Not clear what eHealth offers a politician. Why should they support it?
- Not a “build it and they will come” proposition. Need to get politicians, patients and physicians to buy-in first.
- eHealth is very much a communication and engagement issue.
Before taking questions from the audience, Mr. Gregg interviewed Dr. Blumenthal and Mr. Alvarez. Some highlights of the conversation with Dr. Blumenthal included:
- “Meaningful use” is a powerful concept with which to measure progress. Dr. Blumenthal stated that “meaningful use” was one way to ensure that technology was making a difference. He further elaborated that “meaningful use” starts with where we want to be with healthcare, not with what we want to do with technology.
- Biggest challenge will be creating interoperability. Felt that adoption will happen in any event, if only because new physicians will bring it to the practice of medicine.
- US is employing a “carrot and stick” approach using financial incentives / penalties through Medicare / Medicaid funding.
- When asked about the business case for eHealth, Dr. Blumenthal cited his personal experience as a primary care physician. He stated that he was initially a reluctant EMR user but became a convert through a series of personal experiences. He shared one of these stories in which an alert generated by the EMR gave him the information he needed to cancel a diagnostic imaging test that he was about to order. Dr. Blumenthal used this personal anecdote to demonstrate that hard cost savings that are possible through immediate access to all relevant patient information.
- Thinks that the Scandinavian countries are perhaps the most advanced with regard to eHealth use and adoption. He noted, however, that these countries are considerably smaller than the US or even Canada and are still struggling with a framework for information exchange.
Highlights of the conversation with Mr. Alvarez included:
- Accomplishments to date include:
- Have put standards in place
- Have defined an eHealth architecture that is used by all jurisdiction
- 300 projects currently underway, most of which are in the implementation stage
- Every province is at a different stage, with some provinces, like Alberta, much further along the path to having a comprehensive EHR in place.
- Have made significant progress in diagnostic imaging and telehealth
- While Infoway could have started with EMRs in physician offices, they did not feel that it was the right approach at the time. Now that other core pieces of the EHR framework are in place, Infoway will be committing a significant portion of the recently received $500M federal government investment in to EMRs and interoperability.
- Mused about the challenges of Canadian federalism and noted that with regard to eHealth, the jurisdictions are more collaborative than they are with respect other aspects of health.
- When asked about the business case for eHealth, Mr. Alvarez indicated that Infoway has systematically examined the benefits and identified on the order of $6B in savings. Recent studies of the benefits of diagnostic imaging and drug information systems have shown savings on the order of $1B each.
- With respect to “meaningful use”, Mr. Alvarez stated that Canada has been “muddling along” with respect to adoption metrics and will be borrowing some ideas from the US in this area.
- Mr. Alvarez challenged the belief that it is “taking so long” to implement eHealth. He noted that the banks took decades to go from computerizing their ledgers to the on-line banking systems that we know today. Mr. Alvarez asserts that eHealth implementation is a 10 to 15 year journey and that Canada is making good progress.
This plenary session was probably one of my favorite events at the conference. I continue to be amazed by Dr. Blumenthal’s leadership and was pleased to see Mr. Alvarez acknowledge that Canada could learn some lessons from the US approach.