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Prescriptions for an e-healthy nation

By Chris Atchison | December 12, 2012
Prescriptions for an e-healthy nation
Richard Alvarez

Richard Alvarez is one of the Canadians leading the charge to modernize and streamline this country’s health-care system. And that’s precisely why he faces greater day-to-day challenges than many CEOs in this country.

Just five years ago, most clinicians in Canada relied on paper-based patient records. While almost every other industry in the country, from retail to banking, had long embraced electronic record-keeping and a long list of other digital innovations, the health system was still largely operating with the tools of our grandparents.

Fast forward to today and the picture is dramatically different. Doctors − from general practitioners to specialists − in most major cities now rely on computers to update their patients’ digitized health records. Some physicians can even be seen patrolling the hallways of Canada’s leading hospitals with tablet computers in hand, employing the mobile devices to read X-rays or email prescriptions on behalf of their patients.

So, what’s Alvarez’s role in this radical − and still ongoing − transformation? He is the president and CEO of Canada Health Infoway – the federally funded, not-for-profit organization mandated to speed the move to electronic health records across Canada. As such, hehas worked tirelessly to drive this move home to government officials and health-care administrators, who are desperately seeking cost efficiencies and new tactics to slow soaring health-care costs, which now devour roughly 12 per cent of Canada’s gross domestic product. Reducing wait times, saving money and delivering better patient results, he repeats time and again, begins by leveraging innovative information technologies and supporting their use among clinicians.

While the talking points and theory are simple, the execution is far more complex. Alvarez arrives to work each day facing a raft of challenges relating to the development and adoption of electronic health records. Navigating the incorporation of new technologies into the workflows of Canada’s health-care providers is an undertaking that is as ambitious as it is essential. Then there’s the challenge of interoperability, which requires the adoption of similar standards by the provinces and territories. That’s not to mention managing the inevitable technical bumps along the way.

But ask Alvarez to name the greatest challenge facing Infoway as it works toward achieving its health-care modernization mandate, and he points to something entirely more human. “This is a people issue around aspects of change management,” he explains. “The vast majority of our clinicians have been out of medical school for 20 or 30 years, they weren’t taught how to use the devices that are available today, so their workflow has to change dramatically. They won’t adopt this unless they can see value.”

Demonstrating that value involves staying ahead of the innovation curve and providing key stakeholders, including provincial governments, the health-care community and the technology industry, with the timely and accurate information they need to keep modernizing and save taxpayer dollars by replacing ineffective systems. It’s here that Alvarez and his team have enjoyed perhaps their greatest success and helped drive the most significant changes to the Canadian health-care system in a generation. How? By listening to key stakeholders, displaying a willingness to experiment with new ideas and providing the funding and support to implement real system-wide change.

One such change was improving funding methods for key initiatives. Rather than embracing the traditional way that government agencies typically allotted funding to specific projects, Infoway opted to change the rules. The organization’s strategic partner model attempts to ensure that jurisdictions − usually the provinces and territories − are committed to sharing the cost and other aspects of implementing specific technology projects. If those governments aren’t ready or willing to partner with Infoway, the agency takes its ideas or tools to other jurisdictions that are prepared to commit. “That’s allowed true innovation to occur because it’s resulted in a collaborative approach,” Alvarez says. “In many cases, it’s allowed us to think nationally in all our designs, but act locally.”

Alvarez points to one of Infoway’s investments in Alberta as an example of that localized innovation at work. Cancer Surgery Alberta, a provincial program under the former Alberta Cancer Board, recognized that health IT could help improve post-operative reports, which were still being tape recorded by surgeons and sent off for third-party transcription. The process took about a month to complete and often missed about 50 per cent of the necessary information due to a lack of standardized reporting criteria. Working with surgeons to determine what information needed to be in those reports, the Alberta Cancer Board built the web-based platform that now allows surgeons to record their notes within an hour of leaving the operating room. “It's improved quality control, has allowed for better teaching and is now spreading across Canada to other jurisdictions,” Alvarez says.

In another example, Infoway sponsored pilot projects, providing clinicians at The Ottawa Hospital and Hamilton Health Sciences facilities with secure mobile access to patient information using their tablets. As Alvarez explains, it’s now virtually impossible to pry the tablets away from physicians who have become accustomed both to their convenience and mobile utility for exchanging information.

Of course, sometimes the CEO’s job is simply to fuel innovation in creative ways. That was the logic when Infoway launched its ImagineNation Outcomes Challenge earlier this year. The competition encourages clinical teams to report their use of electronic tools and innovations, all in an effort to accelerate the use and spread of information technology solutions. So far, more than one million uses have been reported. A total of $1-million will be awarded to the teams whose innovations gain the most use across Canada.

In another instance, Alvarez recently kick-started an emerging technology group within Infoway to study key technology developments in areas such as cloud computing, big data, mobility and social networking. His plan is to have the group publish regular white papers to provide information, insight and analysis that may help Infoway’s jurisdictional partners make decisions about the potential application of these technologies for health care.

But what most excites Alvarez is how these efforts to stay ahead of the technology curve and introduce and implement new innovations are benefitting patients. Today’s hard work will result in a greater number of patients having access to their electronic health information, booking virtually all of their medical appointments online, or having a more productive relationship with their doctors. “Your clinician’s role will absolutely change to that of an advisor,” he predicts. “Obviously, they’ll still be doing operations and such, but clinicians will be more wellness counsellors than the sickness counsellors they are today.”

As Infoway moves into its second decade, Alvarez says its next step is to “sharpen our focus on the frontline by giving consumers electronic access to their health information. With the advent of mobility, we also have the opportunity to free clinicians from a location or bedside to make it more convenient for them, allowing us to adopt some of the new mobile technologies that have come along and revamp our focus in that direction.”

Alvarez is confident that the drive to modernize the Canadian health-care system with new digital tools and electronic health records is only gaining momentum. Turning back the clock on these remarkable innovations, he insists, is not an option. “At this stage, our focus groups say Canadians expect this to happen, and they don’t want to see it stop. They’re tired of repeating their health histories over and over again.”

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