The Fight for Progress: Innovation or Inertia?

Change comes slowly in health services, despite an overwhelming need to reflect current science, budgets, and consumer practices. Recent studies indicate that many more Canadians, up to 9% of us, may have diabetes than had been previously assumed. This occurs despite compelling knowledge of the benefits of ‘best practices’ care: a small change in blood sugar makes important differences in the cost and quality of care. An important missing link is the Electronic Health Record, particularly in Ontario. But in Edmonton, Capital Health has recently announced an exciting new initiative to integrate screening and care for the region’s diabetic population – all of them. There is reason for hope.
In health care, inertia always seems to win. Just what is it that makes health organizations and leaders so resolute?
Over four years ago, the Romanow Commission made one prescient plea: let new healthcare money buy change. Well, Canada spent $33 billion more on health in 2006 than in 2002. Has much changed?
To answer this, let’s consider diabetes, a common and serious health condition, and its interface with a key piece of information technology, the Electronic Health Record (EHR). Diabetes costs over $13 billion to treat nationally, has a host of serious complications, and is preventable. An EHR provides the mechanism to collect and present health information from across various domains, such as hospitals, telehealth and diagnostic services, pharmacies, and public health. New reports shed some light on what leadership looks like.
The Starting Gate
Diabetes – A recent study discovered that between 1995 and 2005, the number of known diabetics increased 70% in Ontario. Extrapolated, that would mean almost three million Canadians have the disease. Many more are thought to suffer, though they have not yet been diagnosed. Obesity, ageing, immigration, and better treatments that prolong the lives of those with diabetes are thought to be responsible (1).
In another report, the Health Council of Canada dangles the carrot before us: a mere one percent reduction in blood sugar is associated with 14% fewer heart attacks and 21% fewer deaths due to complications of diabetes. On the money side, research in BC found the combined cost of physician and hospital care for an elderly population was 47% lower for those who received high (vs. low) quality care (2). Clearly, change is needed in diabetes prevention and care. EHR – Healthcare decision-makers have focused on doctors and nurses, on bricks and mortar, and on healing rather than preventing. As a nation, we have not spent enough on health systems. Canada Health Infoway, a federal-provincialterritorial organization charged with implementing health information systems, calls healthcare “the world’s most information intensive industry.”
Currently, health care organizations spend about 1.5% of revenue on information technology and support, versus 4% – 5% in other industries. A fully developed EHR in Canada has been projected to cost $1 billion annually for about ten years, which sounds like a lot of money, but is only two-thirds of one percent of our total direct annual expenditures (3). The key bits are in place (funding, urgency, technology), but health leaders have rarely embraced it.
Infoway projects have been underway for almost two years in all provinces except Ontario, so one-third of Canadians are not even in the game. As of November 2006, Ontario had not yet even approved a comprehensive eHealth strategy, and its major agency, Smart Systems for Health, was in a state of disarray (4).
Now, what if higher prevalence and poor management could be met with better health services that improved health, and lowered costs?
Converging Tracks
In January, Edmonton’s Capital Health Region announced its goal to identify and properly treat 100% of its diabetic population (at least 90,000 people) by 2009.5 Surprisingly, it’s already at the 90% threshold. The tools will be its 3-year old EHR (netCARE), and a new electronic regional diabetes registry that ensures evidence-based care from multi-disciplinary health care teams. Capital Health believes it is the first jurisdiction in North America to organize a systematic and targeted disease management strategy. This is what leadership looks like.
In contrast to Ontario’s failure to execute, netCARE took just one year to develop using a consortium of six international computer systems companies. It spans 13 hospitals, 28 public health centres and specialty care clinics, 9 community mental health services, and many other community care services.
Now What?
Jacques Chirac, President of France, took a different view of the world than most health service leaders. He said in 1998: “There is nothing more dangerous than standing still in a world thatis changing.”
Enough talk? Then let’s make it happen!
1 News release, Diabetes increase surpasses WHO prediction.
2 Health Council of Canada, March 2007. Why Health Care Renewal Matters: Lessons from Diabetes. Backgrounder.
3 Canada Health Infoway, 2006. Beyond Good Intentions; Accelerating the Electronic Health Record in Canada, Executive Summary.
4 Deloitte Consulting, Operational Review Final Report, Smart Systems for Health Agency.
5 News release, January 17, 2007. Capital Health aims to be North American leader in diabetes management.


Categories: Editorial