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The effort to move Canadian medical records from paper to computer has been slow, and after eight years, the country is just a third of the way to its goal of having 50 per cent of those records available electronically by the end of 2010.

Canada Health Infoway, the non-profit organization charged with accelerating access to electronic records, released its annual report Monday. It shows that $1.576-billion was spent between 2001 and March of this year to bring Canadian health records into the computer age.

But, during that same period, just 17 per cent of Canadians obtained health records that could be accessed electronically. That’s far below the goal of 50 per cent that has been set for next year.

Initially, Infoway had aimed to reach 50 per cent this year. But a federal review undertaken in 2006 stated that that goal was problematic.

“It is a very blunt target for a complex undertaking,” said the review, which was released under the Access to Information Act. “The definition of this target is broadly misunderstood, the target itself is likely to be missed, and is not a strong indicator of success.”

Health professionals believe that making the records available electronically will reduce errors, track patient care, and ultimately save lives.

A similar project, Ontario’s eHealth initiative, is mired in a spending scandal replete with lucrative contracts awarded without competitive tenders and nickel-and-dime spending on snacks by consultants.

Dan Strasbourg, Infoway’s director of communications, said it’s too early to assume the new target will not be met.

“The provinces and territories are making solid progress and are currently on track to meet their objective of having the core components of the electronic health record in place for 50 per cent of Canadians by the end of 2010,” Mr. Strasbourg said yesterday.

The federal government allocated $500-million to Infoway in its budget last January.

Although it has taken eight years to get just 17 per cent of Canadians’ medical records computerized, he said it is possible to reach 50 per cent next year because much time has been spent in advance developing the electronic systems.

“Over the past six or seven years, the provinces and territories have been developing those systems,” said Mr. Strasbourg. “In a lot of cases, over the next 18 months, the systems are going to be put in place for the clinicians to be able to use them.”

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EMR Services Canada

EMR Services Canada

Surgeons are now sending “tweets” from the operating room.

That would be a slice-by-slice and stitch-by-stitch description, in 140 characters or less, new to the growing phenomenon of Web-based social media. Electronic medical records, following patients via telemonitoring, wireless health info – welcome to the new face of medicine, experts at a Montreal conference on E-health said yesterday.

Twittering is just the latest innovation, said Peter Waegemann, CEO of Boston’s Medical Records Institute, and a key speaker at the Third International Symposium on Medical Information and Communication.

The three-day conference brought together engineers and health professionals to discuss the latest applications in the field. “mHealth (mobile phones) will be the next revolution in health care,” Waegemann said in an interview.

For example, an African doctor in an area without telephone reception recently text-messaged his medical teacher in England about amputating a patient’s arm. He had never done an amputation and he got his answer, Waegemann said.

Once banned from hospitals for fear of interference, the rehabilitated cellphone should become a prized tool for clinicians, Waegemann said. (Newer cellphones pose fewer safety problems for hospitals.) Four wireless communication companies in the United States are competing for a slice of the digital health care business.

“I predict that 30 million people will have their health records on cellphones by the end of 2009,” Waegemann said. “Your medication, your allergies, previous diagnosis, what your doctor should know … so you never start out with a blank sheet. “You can do it on any phone and with any carrier.”

In California and Arizona, ambulances equipped with smart phones send patients’ medical information ahead of arrival at an emergency room so a hospital can prepare.

Also, some patients are sending text messages to their doctors with questions about their symptoms, particularly in the area of asthma, diabetes and obstetrics. “Doctor, I feel an asthma attack coming, what should I do? I’m doing it with my doctor with high blood pressure,” Waegemann said.

Studies show such “disease management” improves care and saves the health system millions, he said. Once vilified as unreliable, the Internet is now source of information for more than 70 per cent of patients who tend to use it for second opinion, he said.

Patients with chronic diseases tend to be extremely well informed about their health problems, sharing on websites results of treatments, experimental drugs and trials, what worked and what didn’t, he said.

“They share everything. They know more than the average doctor,” Waegemann said. “Practitioners can no longer rely on memory for information learned in medical school 10 or 20 years ago. “Once health care is restructured to the Web, the patient will own the process.”

Montreal conference co-organizer Allen Huang, director of geriatric medicine at McGill University Health Centre, said that twittering, although a modern communication tool, will not be happening from local operating rooms in the near future. Because of limited bandwidth and confidentiality concerns, Quebec hospitals do not allow two-way access to the Internet: for example, to Facebook, twitter or other social media sites.

The conference also touched on electronic medical records and patient safety.

In Detroit, Craig Rogers generated a lot of buzz two weeks ago when he had his chief resident twitter while Rogers removed a large cancerous tumour from a patient’s kidney. Rogers said his goal was to improve communication for doctors, medical students and the merely curious.

By Charlie Fidelman, The Gazette
cfidelman@thegazette.canwest.com

EMR Services of Canada

EMR Services of Canada

For the past decade every provincial and national report on health-services provision has called, in one way or another, for the reform and renewal of primary care–the care provided by front-line health professionals who are a patient’s first point of contact in the medical system.

Primary care is seen, correctly, as being the linchpin of our health-care system. It’s understood, correctly, that if primary care doesn’t undergo substantive change then our health-care system will remain mired in a slew of problems. Reform party founder Preston Manning used to urge us to “catch the wave.” For those who seek the reform and renewal of primary care, now is the time, for the wave might not come by again.

I would like to present a way forward for primary care in Alberta, a system utilizing existing Alberta resources and know-how.

An excellent primary-care system provides very good access to high-quality that can be measured.

What the system needs

Six actions would greatly improve access to primary care for Albertans: – Embracing the principles of the “primary-care home”; – Developing team-based practice; – Adopting access-improvement measures; – Producing more family doctors; – Creating the role of the primary-care nurse, and – Maximizing the potential of our primary-care networks.

There are three requirements for achieving good-quality care: – Having a robust electronic medical record that can link to a larger provincial electronic health-record database; – Agreeing on what “good quality” really means and developing measurable standards around this, and – Paying doctors differently for different activities.

Let’s look at the concept of the “primary-care home.”The idea of a “home” as a place where people receive their basic and ongoing care is becoming better defined in the medical literature. The principles of the primary-care home are: – Each patient has a continuous relationship with a personal physician; – Care is directed by the physician, but may be provided by members of the team; – It is the repository of an individual’s complete health record, and thus is the central point for co-ordination of care; – Quality of care and safety are defined and measurable; – It is readily accessible to patients; – Physician payment supports both individual and population health, and rewards both improvement and sustaining that improvement, and – In the primary-care home, the core team is the physician and the nurse, joined by other health professionals as required. The key to success is that all members of the team work together, bringing to bear the full scope of their training on the care of the individual patient, as well as on the health main-tenance of the practice’s total group of patients.

AIM (or advanced-access)methodology, is now well-known in Alberta. In short, it is a system for organizing a practice organization to continuously monitor supply and demand, workflow, and efficiency.

How will we produce more family doctors? In large part, we will do so by demonstrating to medical students that, by becoming family doctors, they can have a professional life supported by a coherent system that lends itself to an intellectually sustaining, financially rewarding medical practice, adequately balanced with their personal life. This can also be said for primary-care nursing.

The primary-care nurse has the role of managing the care of patients when the diagnosis is known and a management plan is in place. This role will be taken by a registered nurse with skills in areas such as chronic disease management, geriatric assessment, and telephone triage, to name just three. The physician’s role on the team is to handle patients when the diagnosis is not established, or complications have arisen.

In Alberta, we are implementing primary-care networks. These cooperatives of family practices have the potential to offer benefits including such things nursing resources, informatics support, and referral brokerage. There will be many more examples as the burgeoning networks evolve.

Compensating doctors

Other Alberta Advantages with the potential for improving our health-care system are our support of electronic records and the mechanisms we have for how doctors are paid.

Existing programs, including the provincially funded EMR scheme (the physician office support program– POSP),and Alberta NetCare (our provincial electronic-record system), give us tools that allow the integrationandco-ordination of care of both an individual in a primary-care home, and the defined population that the primary-care home serves.

What about paying doctors differently for different things? The widely applied fee-for-service system rewards only one thing: volume. For compensating physicians, our province has developed new payment methods known collectively as an alternate relationship plan (ARP). The ARPs can and will allow practices to develop into primary-care homes by means of different payment mechanisms.

This can lead to financial support for population management and for quality outcomes. “Quality,” in this regard, refers not only to biological markers, but also to measures in clinical care that truly make a difference to our health–such as continuity of care, access to care, and indeed, the very strength of the relationship Albertans have with their caregivers.

Ultimately, the purpose of primary care is to foster continuing, supportive, and nurturing relationships between providers and their patients.

Albertans should realize that we are close to realizing this vision of the primary-care home.We have the materials to build it. We just need a few more carpenters and one or two really good architects.

In this brief overview, I have tried to distil years of thinking and debate, and in so doing have left out much of importance.

Some will see the primary-care home as too physician-centric, others as too idealistic, yet others as too expensive. Some will want to pick apart/analyze/debate the six actions to improve factors for access and the three requirements for quality, and others some will say, “Back to the drawing board.”

The wave, though, is rolling by. Let’s not miss it.

Dr. Richard Spooner is a past president of the College of Family Physicians of Canada and currently is a member of the board of the Edmonton Southside Primary Care Network

EMR Services of Canada

EMR Services of Canada

MONTREAL, June 9 /CNW Telbec/ – Canadian Medical Association President Dr. Robert Ouellet today launched the first online diabetes tool specifically designed for use by family physicians with chronic disease patients. The mydoctor.ca Health Portal now allows patients to share important diabetes-related information – such as blood sugar, weight and exercise results – with their doctor in a secure, online environment.
“The new diabetes tool in the Health Portal puts into action the CMA’s vision to empower patients to take more control of their health,” said Dr. Ouellet. “The Portal is a front-line example of how integrating technology with health care delivery can improve the health of Canadians.”
As simple as banking online, patients will be able to enter the secure portal and input diabetes-related health information for their physician to access and monitor. Blood sugar readings, intensity and duration of exercise completed and lab results can all be shared between doctor and patient, in an easy-to-read, chart format.
“The Health Portal acts as an extension of the care I provide to my patients,” said Dr. Jay Mercer, a family physician in Ottawa and Medical Director for Practice Solutions, and a current user of the Health Portal. “It helps me stay connected with my patients and lets them play a more active role in managing their own health. With diabetes being such a prevalent condition for Canadians, the new diabetes component is a welcome addition to the Portal, and will surely help to improve patient outcomes.”
With over two million Canadians currently dealing with diabetes, the addition of this tool was a logical choice for Practice Solutions, a CMA company, to incorporate into the Portal.
“Our goal is to equip physicians with the tools they need to provide the highest possible level of patient care,” said Larry Mohr, president and CEO of Practice Solutions. “And with current research showing how pervasive diabetes is in our country, as well as how electronic health tracking tools can improve patient outcomes, there was no doubt that a diabetes tool was the next area on
which we should focus.”
The mydoctor.ca Health Portal also includes tools to manage asthma, blood pressure and weight, a personal health record, an interactive health library and secure messaging between physician and patient.

For more information about the mydoctor.ca Health Portal and the diabetes tool, visit mydoctor.ca/media for screen shots, a recorded demo, and backgrounders.

Facts about diabetes

– Over two million Canadians have diabetes and that number is expected to
reach three million by 2010.(1)
– People with diabetes incur medical costs that are two to three times
higher than those without diabetes. A person with diabetes can face
direct costs for medication and supplies ranging from $1,000 to
$15,000 a year.(1)
– By 2010, it’s estimated that diabetes will cost the Canadian healthcare
system $15.6 billion a year and that number will rise to $19.2 billion
by 2020.(1)
– Online diabetes management programs may lead to improved patient
knowledge, engagement and accountability, as well as better
communication between patient and doctor.(2)

About the mydoctor.ca Health Portal

The mydoctor.ca Health Portal was launched in April 2008 as the first physician-driven Canadian electronic patient health record platform (PHR). It features innovative online tools for tracking chronic diseases. The portal, created by Practice Solutions, a CMA company, allows physicians to register their patients with any or all of the online tools to manage diabetes, asthma, blood pressure and weight. Designed by physicians, the portal also provides a personal health record, interactive health library as well as secure
messaging, ensuring a private channel of communication between patient and doctor.

About Practice Solutions

Practice Solutions, is the leading provider of end-to-end technology and practice management solutions for Canadian physicians, which includes its popular PS Suite(TM) software bundle that manages billing, scheduling and electronic medical records for a physician’s practice. We are also experts in consulting services, educational seminars, billing services, lease financing, web portals for physicians and the publisher of physician and patient-oriented magazines. Practice Solutions is headquartered in Ottawa and employs more than 160 professionals across the country.

About the Canadian Medical Association

The Canadian Medical Association is a national, voluntary association that represents over 70,000 physicians across the country. The CMA advocates on behalf of its members and their patients for access to high quality health care. It also provides leadership and guidance to physicians.

——————————-
(1) The prevalence and costs of diabetes, Canadian Diabetes Association
(2) Diabetes Connected Health: A Pilot Study of a Patient- and
Provider-Shared Glucose Monitoring Web Application Journal of
Diabetes Science and Technology, March 2009, Vol 3, Issue II

For further information: Lucie Boileau, Media Relations, Canadian
Medical Association, (613) 731-8610, (800) 663-7336 ext. 1266, Cell: (613)
447-0866, lucie.boileau@cma.ca

EMR Services of Canada

EMR Services of Canada

Ontario’s doctors say a study released on June 6th by the Ontario Health Quality Council (OHQC) illustrates the need to remain vigilant in getting every Ontarian a family doctor and expanding access to Electronic Medical Records (EMRs).

“Every person in the province deserves to have access to the care and expertise of a physician, and Ontario’s doctors will accept nothing less,” said Dr. Suzanne Strasberg, President of the Ontario Medical Association (OMA). “Since 2004, more than 630,000 people that didn’t have a doctor now do. We are very proud of what we have accomplished but we know there is more work
to be done.”

In the most recent agreement, Ontario’s doctors and the government committed to work together to find another 500,000 patients a physician. Dr. Strasberg suggested that one of the most effective ways to achieve this objective is through the expansion of collaborative care models. Ontario’s doctors have long advocated for collaborative health care teams where various health professionals work together under one roof to provide care to a large number of patients.

“The evidence is clear, when physicians and other health professionals work together, not only is there a more comprehensive level of care provided to patients, but it can reduce the strain on the health care system.”

The OHQC study also highlights the importance of EMRs in ensuring continuity of care to patients. EMRs are a critical component in the evolution of the province’s health care system, which is why the OMA has been pushing for the expansion of them into every doctor’s office across the province. To date, more than 3,000 family physicians in Ontario have EMRs in their offices
and by the end of 2009, 4 million patients will have an EMR.

“Doctors who use Electronic Medical Records report patient safety, continuity of care and quality of care have improved,” said Dr. Strasberg. “Ensuring that EMRs are available in every doctor’s office is an important step towards improving and strengthening Ontario’s health care system.”

For further information: or to schedule an interview, please contact OMA
Media Relations at (416) 340-2862 or 1-800-268-7215 ext. 2862

EMR Services of Canada

EMR Services of Canada

The Army’s program for electronic battlefield medical records is preparing to expand to cover sites in the United States. That step comes as the Medical Communications for Combat Casualty Care
program, based at Fort Detrick, marks its 10th anniversary.

“It’s really just gone through its adolescence phase,” said Lt. Col. William Geesey, the program’s product manager. “That summer where you’ve had huge explosive growth and you’re maybe a little bit awkward now. We’re in the college phase now.”

The government chartered the program in 1999, partially in response to investigations into Gulf War syndrome.

At the time, lacking electronic records, investigators couldn’t track service members’ vaccinations, environmental exposures and other possible factors, Geesey said.

Researchers couldn’t rule anything out as a cause, because there wasn’t any information available, he said.

The Army first deployed the program to Kuwait, Iraq and Qatar in 2003.

Now supported by about 240 people, it operates in 14 countries at Army, Air Force and Navy medical facilities.

This year, officials plan to roll out the next version of the program’s system, which will require fewer servers on the back end, and also allow for remote administration, Geesey said.

The program’s managers also want to expand and institutionalize it to the point where it’s being used anywhere the Army provides health care.

Troops coming back from Iraq and Afghanistan are finding that their medical records at their battalion aid stations are on paper, Geesey said.

The program is working with the 3rd Infantry Division, at Fort Stewart, Ga., and hopes to have electronic medical records at the division’s battalion aid stations within six months.

Medical records Army-wide could be electronic within 18 months, Geesey said. All the units have the equipment already, but it’s a matter of figuring out best practices and educating people in using it.

By Justin M. Palk
Frederik News-Post Staff

logo

Columbia Journalisim Review

Campaign Desk – Tudy Lieberman talked to Jonathan Oberlander, a health policy expert and professor of social medicine and health
policy & management at the University of North Carolina—Chapel Hill, to help journalists report the health IT story.

Trudy Lieberman: What do we mean by health IT?

Jonathan Oberlander: It generally refers to the use of computers in providing medical care. Electronic medical records—moving your
paper health records into an electronic format—is a prime example.

TL: Are there differences in what is meant by an electronic medical record?

JO: Some electronic records just have descriptive information like diagnoses and what medications you’re taking. Others go beyond this
and let doctors order prescriptions and lab tests electronically. Some can generate patient reminds for screening services and offer guidelines
that help doctors diagnose and alert them to contraindications for drugs they’ve prescribed.

TL: When did interest in these systems take hold?

JO: It gained momentum in this decade. But in the last four years, it really picked up steam.

TL: To what extent are electronic medical records being used now?

JO: The New England Journal of Medicine has reported that about 17 percent of the doctors and 10 percent of hospitals are using them.
And that means the basic kind of record, not the comprehensive variety.

TL: Why so few?

JO: Primarily the cost, which can be prohibitive for hospitals and small groups of doctors. Both are worried that it’s an investment that might
not pay off. Systems can also be costly and difficult to maintain.

TL: How much does it cost to buy these systems?

JO: The Congressional Budget Office said that, in 2008, the cost for office-based record systems was between $25,000 and $45,000, but there are
systems that are more expensive. For hospitals, we’re talking in the millions of dollars.

TL: Why are electronic records superior to paper ones?

JO: They are thought to be superior because they cut down on medical errors and allows doctors to do a better job. They allow doctors to manage
care because they can track a patient’s progress, and they may also reduce the need for redundant, unnecessary tests that happen because paper
records cannot be located. Electronic medical records can also generate data that help us identify what works and what doesn’t work in medicine.

TL: How will the stimulus package help move providers to adopt these records?

JO: It does it the old-fashioned way—by throwing money at the problem. If doctors and hospitals that participate in Medicare and Medicaid adopt
“meaningful” information technology, they are eligible for bonus payments.

TL: What is meant by “meaningful”?

JO: We don’t know. The National Coordinator for Health Information Technology, David Blumenthal, will make that decision.

TL: How much will these payments be?

JO: Payments won’t start until 2011 and will range from about $40,000 to $65,000 for doctors. For hospitals, we’re talking about millions of dollars.

TL: What is the projected penetration of electronic medical records after the stimulus money takes effect?

JO: The Congressional Budget Office believes that we can reach 90 percent in a relatively short period. By 2019, we can get up to 90 percent for doctors
and around 70 percent for hospitals.

TL: Who really benefits from all this money?

JO: The stimulus package calls for $19 billion to be spent over five years. The industries that make the technology and firms that consult with providers
on how to use it will surely benefit.

TL: Won’t patients benefit too? Can you give some specifics?

JO: If electronic medical records improve patient care by reducing errors or other problems, then, yes, patients can benefit too. Health IT does have the
potential to improve quality of care. Whether that potential will be realized is, however, a very different issue.

TL: Will all this money thrown at IT really reduce the rate of spending on health care, as some believe?

JO: No. Chances are it’s not going to save huge amounts of money.

TL: What do you mean by huge?

JO: The health care cake is very big. IT spending is not even the icing. We spend about $2.5 trillion on health care every year, and it would cost about
$125 to 150 billion annually to pay for subsidies that enable all the uninsured to have health insurance. So $19 billion over five years is, comparatively speaking,
not a lot of spending. The savings from this investment are likely to be a very small percentage of total health care bill. Health IT is not likely to
substantially slow the growth of spending, though it still is worth doing as part of the effort to improve quality.

TL: Haven’t there been studies that show savings in some systems?

JO: There have been studies that show electronic medical records have saved money in the Kaiser Permanente and VA systems. But most American health
insurance does not look like Kaiser or the VA. In fact, American health care is not a system. Promoting health IT here is harder than in countries that have
single-payer systems, or in closed arrangements like Kaiser and the VA.

TL: How much would the federal government save in its health programs if IT were widely adopted?

JO: The Congressional Budget Office estimates that the HIT provisions of the stimulus legislation could reduce federal spending on health care benefits by
about $13 billion over the next decade. But the program will cost about $32 billion to implement in Medicare and Medicaid, so spending on HIT will increase
the deficit by $19 billion or so during that decade.

TL: Do other countries count on health IT to control health care expenditures?

JO: There is no evidence that other countries spend less because they use electronic medical records more than us (and they do). Countries that use
electronic records controlled costs better long before there were such records.

TL: Why is this lack of evidence overlooked by politicians and, to some extent, the press?

JO: It’s an attractive solution for policy makers and politicians, so it has been overhyped.

TL: Why is it so attractive?

JO: Health IT sounds like a rational, sensible, and technical solution—and most important, it doesn’t appear to take on vested interests or stakeholders
like health insurers. That makes it politically useful as a solution. It also promises to improve the quality of care, and politicians like solutions that both
control costs and improve quality.

TL: Can you amplify this dual solution a bit more?

JO: Cost control involves pain. So if you have pleasure—in this case, meaning better quality—that means you can run for reelection on something positive.
When you run for reelection, you don’t want to run on pain and lost income for constituents. When you’re doing something that sounds better, it’s a win-win.

TL: What cost control measures would result in greater savings?

JO: We could save money by setting budgetary targets for national health spending. For example, the Clinton administration proposed to cap increases
in health insurance premiums. We could also create a system that let private and public insurers coordinate a national payment schedule for medical
providers. That would help us restrain prices for medical care.

TL: Will America ever adopt these measures, or is medical inflation destined to relentlessly rise forever?

JO: As the saying goes, forever is a long time. If Congress adopts legislation that substantially increases insurance coverage—and there is a good chance
that will happen this year—the incentives for the federal government to restrain spending will become stronger since the government will be spending
lots of money to subsidize people to buy insurance.

TL: What will happen down the road when everyone realizes that health IT has not produced the promised savings?

JO: We will eventually discover that we can’t compute our way out of the health care cost problem. So the more important question is: What effect
does health IT have on the quality of medical care? So far, the evidence that electronic medical records improve quality and outcomes is quite mixed.

TL: Can the systems in use today talk to one another?

JO: We don’t have a national health IT system that is interoperable. Interoperability means that records from one doctor’s office can actually speak to a
doctor in a different office or to a hospital. To really be effective in managing care, that sort of information sharing must happen. The Kaiser and VA systems
are integrated systems, and that may be one reason they have better results.

TL: Is there a requirement that systems be interoperable?

JO: I think the stimulus legislation requires hospitals to make progress in this area before receiving federal money.

TL: What is the key story journalists should be sniffing out about health IT?

JO: How the Obama administration defines the use of electronic records. Here it’s not just a case of the devil being in the details—the dollars
are in the details.

TL: What other stories should the press be tackling?

JO: I would say there haven’t been many stories looking at who stands to profit from the money we are spending on IT—with the exception
of The Washington Post. I also think there needs to be more attention to the experience of Kaiser and the VA. The question of why providers
are not using the VA’s VistA system, even though it’s available to them, is an interesting story that The Boston Globe highlighted.

TL: What does lack of acceptance about the VistA system, which is freely accessible, say about American marketing and sales practices?

JO: We have a fragmented health system, and that fragmentation shows up in many ways, including the marketing and sale of multiple
health information technology systems. That decentralization has advantages—it may produce more innovation. But it makes coordination
quite difficult. If health IT is going to help us better coordinate medical care delivery, first we have to ensure that we have a coordinated health IT system.

EMR Services of Canada

EMR Services of Canada

Canadians and Americans aren’t so different: Tim Hortons and Dunkin’ Donuts, poutine and disco fries, professional hockey and professional wrestling — there’s some truth behind that “51st state” joke. But despite our similarities, there’s a glaring difference between us that we can’t seem to reconcile: health insurance.

Last fall, in which a Canadian federal election preceded the American one by just three weeks, serves as a case in point.

Throughout the Canadian campaign, the mere mention of expanding the role of private insurance set off public apoplexy. During the American campaign, a Canadian-style single-payer system has been deemed equally ludicrous as its converse in Canada, the thinking apparently being that letting the government run the health insurance plan is tantamount to asking a five-year-old to change your car’s oil: it’s sure to be messy, expensive, frustrating, and somebody’s likely to get hurt.

Both the American and Canadian interpretations of health insurance reform can’t be correct. Where’s the truth in all of this?

It has been suggested for years that in reality neither of us is right, that some sort of ideal compromise existed. Eventually the United States and Canada would, after experimentation and study revealed an enlightened pathway, reach an effective, sensible equilibrium between private and public health insurance — or so the theory went. This notion is known in comparative health policy studies as “convergence theory” and was especially popular in the early ’90s, when the Democrats were ascendant and Hillary Clinton was hard at work on drafting legislation to create a national health plan for the U.S.

We all remember what happened: the plan was destroyed by a combination of its own complexity, dissent within the Democratic Party, private-industry lobbying, and Republican scaremongering. The last fifteen years saw Canadian and American health policy remain as far apart as ever.

But, lo and behold, convergence theory was back again this year as the Democratic primaries saw the return of talk about universal healthcare and insurance mandates from Clinton and John Edwards. For a time it looked as though Canada was back in vogue in Washington. But University of North Carolina at Chapel Hill professor Jon Oberlander, the author of the 2003 book The Political Life of Medicare, recently warned me about the turn of events, “There might be more of a convergence in rhetoric than in reality.” Right he was. The Democrats once again adopted a relatively centrist platform in the general election.

Canada’s single-payer approach is far from perfect, of course. Wait times are dangerously long in some cases, remuneration for physicians is lower than in the U.S., and medical technology lags behind. But for all its shortcomings, the overall cost of delivering healthcare is half in Canada what it is in the U.S. while health outcomes and mortality rates are essentially equivalent, and the discrepancy in healthcare quality between rich and poor is vastly reduced in the Canadian model.

Nevertheless, the prospect of following the Canadian example has lost what little currency the idea once had in the United States; a Canadian-style schema is as anathema to mainstream politics as ever. McCain’s plan would move the U.S. even further still away from Canada. And keeping in mind Obama’s modest tax plan has been blasted as Communist, just imagine what a call for universal healthcare would do to him; his campaign realized early on it was political suicide to propose anything like what exists north of the border.

“There are still a lot of people in the U.S. for whom ‘socialized medicine’ is still a dirty word,” Oberlander told me. “That’s why when John McCain calls Barack Obama’s plan ‘socialized medicine’ the campaign wants to shoot that down immediately. Those are fighting words here.”

Over at least the next four years Canadian healthcare will remain as foreign to Americans as ketchup chips or Bob and Doug McKenzie. Meanwhile, at the other end of the spectrum, Canadian forays into private health insurance have been few and far between, and severely limited in scope by existing laws.

In practice, convergence theory looks to have been a failure.

EMR Services of Canada

EMR Services of Canada

Ontario’s McGuinty Government defends eHealth agency for spending millions on consultants

TORONTO – Spending $67 million over two years on consultants is part of the “expensive undertaking” tasked to a government agency that’s developing electronic health records in Ontario, Premier Dalton McGuinty said on Wednesday, May 13, 2009.

The Smart Systems for Health Agency – now part of eHealth Ontario – spent about 15 per cent of its $225-million annual budget on consultants, including pollsters, even though the agency employed 166 people last year with annual salaries exceeding $100,000.

It’s tough to recruit top experts to build a provincewide system by 2015 when President Barack Obama is pushing a similar project in the U.S., McGuinty said. “That presents some competitive challenges for us when it comes to getting access to the best human resources, but we’ve got to drive this as quickly as we can,” he added. “And it is an expensive undertaking.”

The agency hired Ipsos Reid and others to conduct customer satisfaction surveys to see if the technology would meet the needs of its 50,000 customers, said eHealth Ontario CEO Sarah Kramer. “It is part of any good corporation’s continuous quality-improvement efforts to find out what their customers are thinking about, the types of services they’re receiving,” she said.

Sometimes it’s cheaper to bring in consultants to do specialized work than hire staff who aren’t needed for the entire project, Kramer added. The consultants’ fees are not unreasonable given that Obama is investing $50 billion over five years on e-health, said Health Minister David Caplan.

By contrast, Ontario expects to spend another $2 billion over the next three years. “I know that as we ramp up a new agency and organization, that there will become less of a reliance on outside consultants and more work done in house,” Caplan said. But he stopped short of promising sanctions if the fees continue to climb.

The $67 million is another black mark against the agency, which has gobbled up hundreds of millions of dollars with little to show for it, said interim Progressive Conservative Leader Bob Runciman. “This is a real problem, I think, in terms of the efficiency and effectiveness of this government,” he said.”We’ve seen the people involved wasting money hand over fist, whether it’s on travel or entertainment.”

Documents obtained by the party through freedom of information laws showed the agency spent at least $26.8 million on consultants between 2005 and 2008 and issued almost 300 contracts in a single year. The agency also spent more than $200,000 on meal and travel expenses between October 2008 and January 2009, the Tories said.

The Progressive Conservatives have long complained that the agency’s spending is out of control. It’s time for the government to pull the plug on its multimillion-dollar “flop,” said NDP Leader Andrea Horwath. “It is outrageous,” she said.

“Just think about what kinds of differences we’d see in our health-care delivery if we had some of that money – a portion of it even – invested in things like home care, invested in things like long-term care. I mean, there are so many other places where that money would actually make a real difference.” The province’s auditor general is examining the government’s expenditures on e-health and is working on recommendations for the agency, Kramer said.

The government quietly shuttered the Smart Systems for Health Agency last fall and replaced it with e-Health Ontario, another body charged with the same task of creating a system that would allow people’s medical records to be shared electronically among health professionals.

The opposition parties say the government wasted five years and $647 million in its attempt to develop electronic health records before the project was shut down and started all over again.

Maria Babbage, THE CANADIAN PRESS

EMR Services of Canada

EMR Services of Canada

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Jay Byers
President
EMR Services of Canada
info@emrservicesofcanada.com

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