Bonjour. Good afternoon.
Madam Chair, members of the government, and members of the New Democratic Party and the Liberal Party, thank you for the opportunity to present to this House of Commons Standing Committee on Health my views on the costs of adopting new technologies in the health care system.
My name is Professor Carolyn McGregor, and I am the Canada Research Chair in Health Informatics at the University of Ontario Institute of Technology, at Oshawa, in Durham region.
l'd like to talk about the costs of implementing and using new technology in the health care sector, specifically as related to transforming health care through the adoption of new technology, and how doing so can impact upon the patient's journey, because this is a fundamental focus area, and about integrating that new technology with other existing technologies and analyzing the implementation and integration with analytical tools.
Patient journey modelling is using business processes to create diagrams that show the path a patient takes through the health care system: what health care workers see, what steps and procedures are performed, which technologies are used to support their care, and where the information about them is stored within the health care system. The ultimate goal is to reduce duplication, build efficiencies, streamline processes, and improve patient outcomes.
I have led collaborative research engagements between the University of Ontario Institute of Technology and two Ontario mental health providers, Ontario Shores in Whitby and Providence Care in Kingston, for this express purpose. Both were planning to move to new electronic health records.
The first engagement was with Ontario Shores. The move to the new electronic health record had the support of the senior leadership team. We worked with their health informatics department to help them determine what types of personnel should be involved in the project in addition to them. We assembled a team of health care workers from various areas of Ontario Shores and various roles, including a psychiatrist and nursing staff from several of the units.
We gathered some initial information about the patient journeys for a couple of their units and were then able to show the initial diagrams for their review. We were able to show that our diagram approach allowed them to see the patient journey more clearly than just doing a flowchart or describing what they do in words would permit. In the hour that followed, they were able to recognize that there was duplication from one role to another that could be removed to create immediate benefits for their patients.
To create the models for the whole organization would take time, so we provided them with some of our fourth-year health science students to assist with creating the models, as part of an all-year research course. This provided fantastic real-world experience for the students and gave Ontario Shores the additional resources they needed for the task. The models contained as much information as possible about the amount of time activities took, which health care workers were involved, what forms and systems, etc., and if there was a wait, they reviewed and noted how long it could be.
Through the remainder of the year and through summer internships, the students and project team worked to adjust the new models to show what life would be like with the new electronic health record. They were able to see what activities could be removed altogether, as they would be automated by the new electronic health record, such as communicating information between departments. They were also able to see what activities would require staff in various roles to work differently as they began to work with the new electronic health record.
These new and old models were put on the walls in the lunch and meeting rooms all around Ontario Shores so that all the staff, as they went about their work, could stop to look and think about how their work was going to change. This really helped the staff to see how their working environment was going to change and to see what that change would mean for their patients and the caregivers. We provided Post-it notes on which they could put comments on the old and new models, so that they could provide input as well. We followed similar steps in our partnership with Providence Care.
The results of the two partnerships clearly outlined current processes. We identified potential areas for change, gaps in processes and policies, and a pathway to improved care. Ontario Shores is now using the new electronic health record, and Providence Care is well on the way to full adoption. Our collaboration with Providence Care was reported in the February 2012 issue of Hospital News, on page 32.
As for the students engaged in the research, some were offered positions within the organizations, some have gone on to medical school, one became a consultant in the area, and the others continued at our university, in graduate studies.
The benefit of patient journey modelling is that it goes beyond current practice. It will allow you to appropriately plan for future adoption of new technologies and processes and for how best to integrate them into the health care system.
My primary research area is the creation of clinical decision support tools or analytical tools that help clinicians in critical care settings, and in particular in neonatal intensive care. I collect physiological data from medical devices within neonatal intensive care units for every breath and every heartbeat to see whether, through this data, we can detect illnesses such as infection earlier or can improve surveillance to reduce such complications as blindness or brain damage.
This is one of the earliest research projects in health care under the area known as Big Data. This research project, known as Artemis, is in conjunction with the Hospital for Sick Children in Toronto and the IBM Canada Research and Development Centre. We have partners in the United States and in China.
This research is also one of the flagship strategic initiatives of the FedDev-funded Southern Ontario Smart Computing Innovation Platform. SOSCIP is the acronym. It is also a recognized research project of the CIHR-funded Canadian Neonatal Network. Eventually this research will lead to new decision support tools for improved patient care, but this type of transformation will require a dramatic change to clinical guidelines, and patient journey modelling will help us to address how best to implement these transformations.
The costs go beyond the technology itself. Budgets for technology adoption within health care need to include funds to support informaticians and time release for clinicians and practitioners so that accurate patient journey modelling can be developed to support the new technology adoption.
The American Medical Informatics Association, together with the American Board of Medical Specialties, has defined recommendations for a clinical informatics subspecialty within medicine. Within the recommendations for that subspecialty, they state that clinical informaticians need to use their knowledge of patient care, combined with their understanding of informatics concepts and methods, to assess information and knowledge in order to characterize, evaluate, and refine clinical processes, to help develop and refine clinical decision support systems, and to lead across all of those initiatives.
The establishment of clinical informatics as a recognized subspecialty within the medical profession in Canada will reflect positively on the maturation of technology adoption in health care. Patient journey modelling essentially addresses Health Canada' s stated initiative to implement business process changes for efficiency gains. This is an initiative I fully support, as it provides the mechanism to identify efficiencies, streamline processes, and provide better patient care at reduced cost.
We also need to plan for long-term costs associated with fully integrating new technologies with other associated technologies within the health care system. Technologies need to be able to send and receive information in direct support of the patient journey easily, efficiently, and accurately.
In the case of Ontario Shores, they require technology for the electronic health record, but also systems for pharmacy, bed allocation, finance, accounting, billing, human resources, and analytics, and these are not all usually available within the one software solution.
Finally, the true costs, benefits, and savings of each new technology adoption are best understood through the use of organization analytics with metrics from before and after the business process change. Funding must be allocated to the establishment of new or adaption of existing analytics tools to enable the recording and visualization of the metrics relating to increased efficiency, reduction in medical errors, and improved patient outcomes.
In Ontario, the balanced scorecard has been used as a standard way to report health care organization performance. This approach enables not only the reporting of financial results but also patient quality outcome metrics, together with information about the degree of organizational improvement. We need to ensure that as much as possible, the information to create these balanced scorecards or other forms of organization performance reporting is gathered automatically from the other computing systems to ensure accuracy and timeliness of information.
In closing, funding for only the technology itself—the hardware, the software, and the networking—is not enough. Policies and funding frameworks are needed that holistically support technology adoption in health care, if we are to truly capitalize on the benefits of new technologies leading to better health care for all Canadians.
As a Canada research chair, l would be pleased to continue to support this working committee to help develop these policies and funding frameworks.
Merci beaucoup. Thank you.