Dr. Peter Rossos
Chief Medical Information Officer, University Health Network
Good morning, Madam Chair and colleagues. I'm honoured to be here to contribute this morning.
I'll summarize the present state of e-health and telehealth in Canada, and then provide you with an example of telehealth within an organization, the University Health Network. Then I'll suggest a few recommendations for e-health and telehealth.
Given the number of clinicians in the room today, I thought it would be appropriate to start with a case presentation. We have a large country with a small population distributed thinly along the Canada-U.S. border. One of the key variables is that we're all getting somewhat older.
As a result of these and other factors, we see there has been an exponential rise in total health expenditures, and this is challenging the sustainability of our system. In comparison with other OECD nations per capita, we spend toward the top of the cohort.
In looking at the adoption of electronic medical records, I draw your attention to the HIMSS Analytics maturity model for the adoption of electronic medical records within hospitals. It's divided into seven stages. Within the United States, presently over 21% of hospitals are in stages five through seven. In contrast, and this is data from the Ontario Hospital Association, most Canadian hospitals are within the lower half of the scale.
If we look at electronic medical records and hospital information systems across Canada, there are some general trends. Community-based electronic medical records tend to be local, smaller vendor solutions. They have been incented through provincial and national programs, and they tend to focus on primary rather than specialty or interdisciplinary care.
On the hospital side, most of us have foreign vendor solutions, many of them on legacy platforms. To bring this information together, we have existing or emerging regional electronic health records. Many of those involve consortia between large Canadian companies, Telecom Canada, for example, and foreign commercial off-the-shelf solutions.
It's important to remember that part of our battle, at least on the health care organizational side, is that most of these legacy systems were not initially designed for credible care. This has created challenges in workflow, database structure, and interoperability.
On the health care side, there are challenges having to do with standards, interoperability, customization, fragmentation of the marketplace, regulation, and user adoption. Standing back, we have to think what we can do that's affordable, achievable, effective, scalable, and supportive of the spirit, structure, and values of the Canada Health Act.
Over the past 10 years, Canada Health Infoway has taken us a significant way on this journey. Here I present our pan-Canadian electronic health record service blueprint. Certainly, Mr. Alvarez will comment further.
At this point, I'd like to highlight within a single health care organization how we've applied some of these information and communication technologies by featuring the telehealth program at the University Health Network here in Toronto.
We use information and communication technology to deliver health service, expertise, and information over a distance. This can be either real time or store-and-forward telepathology or teleradiology. We use telehealth to advance our patient-centred care initiatives to reduce travel, costs, time, discomfort, and, for many patients, the significant risk of travelling to receive specialized care that's not available closer to home. We've also calculated environmental benefits. That appears in an appendix to the slide deck. In the end we're all committed to this as the right thing for our patients.
At UHN, most of our telehealth occurs through two-way video conferencing over secure networks, very much as we're interacting today. We try to replicate the same workflow as face-to-face visits through our Ontario telemedicine partner, which you'll hear a little more about from Dr. Ed Brown. We also provide interprovincial care, despite significant regulatory barriers.
In this particular graphic, you can see that at most tertiary and quaternary hospitals, the focus of our care is around advanced medical and surgical care, cancer care, and transplantation medicine. The next geographic slide illustrates that our volumes have been increasing exponentially over the past 10 years, despite relatively fixed program costs and a very small team. Geographically, most of our care is provided within Ontario; however, we have a number of programs that have spread nationally.
I'd like to offer a few respectful suggestions for next steps.
First of all, I think it's important that we address issues around designing our health care IT systems and our strategies for telehealth. We must address chronic disease to better deal with morbidity and costs to bend the curve that we demonstrated earlier in the presentation. We must better connect patients and providers from the perspective of efficiency and quality, empower patients to better manage their disease and self-efficacy, and connect providers to reduce medical error.
Second, on the technology side, there is much we can do. To better leverage economies of scale, we can consolidate, upgrade, and replace systems, and we can improve connectivity and interoperability between existing systems. Then to fill the significant gaps we can support and fund innovation in an entrepreneurial fashion by supporting technology research and development and commercialization initiatives, and by creating and reinforcing clinical communities that will advance best practices, standards of care, reporting, and adoption. We can leverage best practices within IT itself, through lower cost agile development, the use of web technologies, better application of analytics, and moving toward more personalized medicine and care.
Certainly, as a third paradigm, none of this can occur without appropriate governance and accountability. That's where leaders like you, obviously, have to help us with alignment of our efforts around patient-centred care and chronic disease management, and with international comparisons and benchmarking to ensure we're meeting targets around health outcomes, access, quality, and safety, and ensuring that investments within our health system are aimed at the performance and adoption targets that we set forth.
As part of the Canada Health Act, we need both patients and providers who have appropriate mobility, and we support universality and accessibility through telehealth and the reinforcement of care communities.
As an individual clinician who has been involved in this process now for almost 15 years, I remain extremely optimistic and passionate. I think we can all work together as patients and providers, payers and managers, industry and innovators to achieve these goals. I think the work you're doing is a very positive step. Once again, I thank you for allowing me to contribute today.