“Countries that rank highest on e-health surveys,” says Keshavjee, “focused first on getting systems into the offices of family doctors and specialists. There’s a good reason for this: Health care is almost always delivered locally.” Building a national storehouse of patient information won’t be much use to anybody, he says, unless you convince the country’s front-line health-care providers – who already store that information on paper – to go digital.
To get a starker sense of our predicament, we need only look abroad. The New York-based Commonwealth Fund ranked Canadian doctors last among 11 wealthy nations in the EMR adoption rate. New Zealand and the Netherlands have built electronic health-care systems for a fraction of what Infoway has now lavished on software systems that, as yet, offer little benefit to patients or clinicians on a national level.
Even Belize, a tiny impoverished Central American nation that spends one twelfth what Canada spends per patient, has built an electronic health-care system far more comprehensive than anything yet available in this country – and much of its success is due to Canadian innovators. Dr. Michael Graven, assistant professor of medicine at Dalhousie University, co-designed Belize’s national health information system. “Working in developing countries makes you develop lean and mean work habits, ” he says. “Infoway got very comfortable negotiating among many vendors, with the focus only on software and hardware.” The salaries of hundreds of federal e-health officials and computer engineers consume over $22 million annually – not far from the $30 million New Zealand spent to connect all its doctors permanently.
In the United States, e-health investments by major institutions are yielding better health care at lower costs – and paint a picture of what a patient-centered EHR could accomplish in Canada. The Veterans Health Administration (VHA), a government-run system that serves over five million patients, experienced an extraordinary turnaround after adopting EHRs in the mid-1990s. Once saddled with the worst health-care record in the United States, the VHA today is celebrated for its success in keeping illnesses such as diabetes from becoming full-blown crises. This, in part, is due to in-home monitoring devices that measure a patient’s vital signs and symptoms round-the-clock. The telehealth innovation harnesses the data in EHRs and allows staff to make timely interventions that prevent expensive trips to the hospital for patients.