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From Toronto Star at http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1158961811221&call_pageid=968256289824&col=968342212737

$125M needed to speed e-health

• Electronic record keeping could be in place next year, agency says
• Would build on success of Child Health Network's computerized files

Sep. 23, 2006 - TYLER HAMILTON, STAFF REPORTER

Most Ontarians could have a basic electronic health record by the end of next year if the province expanded a system that already exists for young patients, according to the agency overseeing electronic health infrastructure.

The price tag for getting the ball rolling: $125 million.

Electronic health records have been touted for years as a way to reduce costs in the health-care sector and improve patient care, and their creation was a key recommendation in the Romanow report on the future of Medicare four years ago.

The Smart Systems for Health Agency, charged with electronically linking 150,000 health-care providers across Ontario, has proposed that the Ministry of Health fast-track the move toward a province-wide e-health record by building on the success of the electronic Child Health Network, which already gives 36 hospitals and health centres across the province shared access to a secure database containing medical records of patients under 19 years old.

More than 5,300 pediatric physicians and health-care workers are now using the provincially funded network, which was spearheaded by the Hospital for Sick Children and has been in operation since 1999.

"It's a neat application," Smart Systems chairman Michael Lauber said in an interview with the Toronto Star. "It gives the doctors a lot of good information to work with."

Records include everything from personal information and doctor's notes to X-ray and laboratory results. Authorized doctors are able to see the records and add to them over a patient's lifetime. As the system evolves, it's expected that patients would be able to securely view their own e-health records online.

Andrew Szende, chief executive officer of the children's health network, said a system expansion would require some tweaking and more data storage to accommodate adult records. He emphasized that the network was secure, pointing to a seven-year track record of no privacy or security breaches.

"It's been looked at by the Smart Systems people, the government and the privacy commissioner and everybody is satisfied that it not only meets but exceeds the security needs and confidentially requirements," said Szende. "So far, we haven't heard anybody say that this was not a good idea."

Lauber said it makes more sense to build on what already works "rather than reinvent the wheel," and Smart Systems appears keen to move forward after being criticized for not acting quickly enough.

A Star investigation last November revealed that the little-known agency, established four years ago, has burned through more than $260 million since 2001 on e-health infrastructure projects that have been riddled with delays and so far have failed to demonstrate value — including a standardized e-health record — for taxpayers.

Following the report, Smart Systems' board of directors was overhauled and the agency is now the focus of a ministry-led operational review, which is expected to be complete within the next five to seven weeks.

Lauber, who was brought on to lead the restructuring of Smart Systems, said he's committed to making the agency more transparent. He said a privacy audit will soon take place and a national search has begun for a new chief executive officer after the recent resignation of current CEO Michael Connolly.

"There's still some housekeeping to do," said Lauber, former CEO of the Ombudsman for Banking Services and Investments. "This organization is transitioning from an infrastructure and build mode to client services and delivery."

He said Smart Systems has taken its e-health record plan to the government and is optimistic the ministry will accept the proposal before year's end.

Patient files today are largely collected in folders and stored in cabinets. Referrals and lab results are relayed mostly by fax machine, while lab images and hospital reports are most often received through mail and courier. Health-care experts say it's an inefficient system prone to error — sometimes with deadly consequences.

According to a draft of the proposal obtained by the Star, Smart System's first step would be to combine data from the province's existing laboratory and drug-profile databases with the child health network.

"The implementation of phase 1 of the (electronic health record) strategy will immediately provide a significant amount of data on a significant number of patients to a significant number of (health-care) providers," the document states.

Lauber said establishing an e-health record is top of mind for the provincial government and that he expects a major push over the next five years to get a province-wide system in place. "The issue is not technology. It's really a management issue."

Timing could be key. The next provincial election is just over a year away and the Liberal government is eager to show progress on a number of files, including health care.

But getting the job done will require another big injection of funds. Smart Systems, according to its draft proposal, said phase 1 of the plan requires a $125 million one-time investment in 2006-07 and an "annual increment of $40 million for ongoing deployment and operations."

Each health record would gradually contain more information over time. "The question is how much of it could be populated with information and how quickly," said Szende.

"With every field of data you add, you're going to attract more and more doctors, nurses and therapists," Szende added.