Can technology improve Manitoba’s health-care system?

Industry experts give their opinion

Trevor Bekolay, Volunteer staff

Technology has improved how we interact with many systems. ATMs and online banking let us avoid standing in line for bank tellers. We can shop for anything online and have it delivered right to our door. Every semester we register for classes online. Yet the health-care industry has not evolved at the same pace; every time we step into a health-care facility we still expect to spend hours in waiting rooms filling out forms that we have filled out many times in the past, only to be sent to other areas of the facility or even of the city to get proper care. Can new technology improve our health-care system? This is the question that was explored in the Smartpark Lobby Boardroom on the morning of Jan. 22.

Brian Eckhardt, president of InfoMagnetics Technologies, began his talk by noting, “There are a lot of people who are skeptics and believe there is little return on investments made in technology in health care today. But it seems that we, as Canadians, have this fundamental belief that better management of our health information is needed.”

Eckhardt explained some of the challenges in managing our health information. The amount of data collected over a person’s lifetime is large; every time a health-care facility is visited — whether it is for emergency care, immunizations, picking up prescriptions, regular checkups, or for any other purpose — records are kept to ensure better care over time. Not only is the number of records large, the records come from many different sources, each possibly storing the data differently. Aggregating all this data is more difficult due to privacy concerns; Manitoba’s Personal Health Information Act stresses that persons and organizations can only collect as much information as they need for a stated purpose. Many health-care professionals are frustrated with the amount of bureaucracy involved in obtaining the patient information necessary to provide the best care. At the same time, the privacy and security concerns are real and complicated.

The solution to the disjointed nature of electronic medical records is to adopt standards and centralize information in secure repositories. Manitoba has been proactive in some areas. In 1980, the Manitoba Immunization Monitoring System was launched, providing monitoring and reminders to help achieve high levels of immunization in the province. In 1994, the Drug Program Information Network connected Manitoba Health and all pharmacies in Manitoba to a central database containing records of all pharmaceutical dispensations. By the end of March 2008, the provincial client registry will be used by all health-care facilities in Manitoba; the registry provides a patient’s latest known demographic information. Many provinces lag behind Manitoba in implementing programs like these.

At the same time, Manitoba lacks central locations for lab and diagnostic imaging records. Some of the current systems are also showing their age; the Drug Program Information Network was launched in 1994 and lacks some information that would be useful to health-care providers. Perhaps most importantly, primary care facilities are not using the electronic health records that exist. The National Physician Survey released this month states that 26.1 per cent of physicians use a combination of electronic and paper charts and that only 9.8 per cent use purely electronic charts.

However, even if all physicians were to switch to electronic charts and health records, the problems of long wait times and inconvenient patient flow would remain. Dean Yergens, manager of medical informatics at the U of M’s faculty of medicine, has worked on technology to mitigate this problem and shared his expertise at the seminar. “Patients assess their quality of health care based around how long they wait,” he notes. “People talk about how long they wait as an indicator of the quality of care.”

Improving wait times and patient flow begins with constructing a model of a health-care facility, such as a hospital, and tracking how patients flow from ward to ward. Over time we can see some historical trends emerge while still tracking patients in real time. Despite this sophisticated tracking technology being around for over 20 years, many health-care facilities are still managing patient flow manually, which contributes to wait times.

More recently, researchers have been moving towards more intelligent systems that can make predictions based on historical trends and the current state of the system. These intelligent systems can determine bottlenecks in patient flow: areas where patients wait for long periods of time and times in which many patients are waiting. Identifying these bottlenecks aids in streamlining the system by balancing out the workload over time. Being able to predict what the hospital will look like in the next few days can help ensure that enough people are staffed to work each day.

These systems are not simply good ideas; they have had tangible benefits. By examining the amount of activity throughout the day, it was shown that at a certain hospital there tends to be more activity first thing in the morning and then less and less activity as the day goes on. The staff was able to balance out the activity by examining why mornings were so hectic. Another example occurred when the Calgary Health Region was formed and hospitals needed to downsize. Using historical data provided by these systems, it was shown that critical care could not be sustained with a lower number of beds; so, while other areas were being downsized, critical care grew slightly.

Yergens recently helped implement a cost-effective electronic patient management system in a remote region of the Philippines. “These other countries are able to move forward because they don’t have to deal with a lot of the infrastructure that we’ve built up over time in terms of our policies and bureaucracy. We honestly have to have the will to start to push these things and make them happen.”

If much of the technology to improve the health-care system already exists, then who is accountable to make sure these new technologies are being implemented to provide better care? “All of us,” says Eckhardt. “Government, education, R&D, vendors, providers, and patients. . . . Maybe the largest disruptive agent of change in the future is the relationship our children will have as patients and providers. If you tell them, when they become a patient, that they can’t do e-mail with their doctor, they’re going to think you’re somewhat strange.”