Cost of potentially life-saving health technology a tough pill to swallow
Would you swallow a pill without asking questions?
Would you let your child, or parent, blindly do the same? Of course you wouldn’t. Not when your health or the health of someone you loved, was at risk.
Yet, collectively, we already have done just that, and we keep doing it. Healthcare is the largest spending item in our provincial budget, yet instead of asking questions and demanding answers we keep accepting the assurances of the experts in the Department of Health that they are doing the right thing, every time, regardless of the costs or the results.
How do we know for sure that they are doing the right thing, making the decisions for the right reasons, if we don’t ask questions? Where is the evidence? What does it say? What are the results? How are we really doing and what does it mean for me, for you and for Nova Scotia? We need to know, and we need to know now.
Take PHRs and EMRs, as an example. These are two forms of electronic health records. A PHR is a Personal Health Record. It is an electronic record or file where your health data and information is compiled and maintained by you, the patient. The intention of a PHR is to provide a complete and accurate summary of an individual’s medical history which is accessible online by you. An EMR is an Electronic Medical Record, a digital version of a paper chart that contains all of a patient’s medical history from one practice (your doctor’s office).
These two tools are potentially life-saving innovations that will better able you and your health providers to share information and understand each other, and the state of your health, in real time. They make sure that you, the patient, are engaged directly in your own care. They make sure all of your health providers know exactly the same things about you and your conditions and the care you have received. You, your doctor, your nurse, your pharmacist, your therapist and everyone else, all know the same things, at the same time.
The evidence is beginning to build, however, that the health department’s prescription for EMRs and PHRs is faulty. But no one is asking these questions and demanding answers.
The Department of Health chose an Ontario company, Nightingale, to provide EMR services, and is sticking with them despite the fact that the majority of Nova Scotia doctors have opted out. Nightingale is the most expensive EMR product available in the province, they have financial incentives from the province that no other provider (including Nova Scotia companies) have access to, and their customer service and support team is in Ontario (so are the taxes that they pay). About $11.5 million has been spent over the past six years (a big investment) for a technology that was supposed to be best in class. About $7.8 million in license and support fees alone. Repeated media reports over the past year have highlighted the failure of this technology and the lack of support and uptake from Nova Scotia physicians.
A Nova Scotia company, Medical Office Management systems (MOM), has been in business for more than 30 years, originally started as a scheduling and billing system. Significant investments were made to upgrade the technology to meet the needs of physicians and their patients. It has taken no government money, has a proven track record, and has 70 per cent of all family doctors as customers. MOM is owned and financed by the Co-operative and credit union sector of Nova Scotia, through Connecting People for Health Co-operative Ltd (CP4H) www.healthconnex.ca. CP4H and MOM have been consistently denied access to the Department of Health EMR system, despite a commitment to meeting all their EMR standards and accreditation, at no cost to the province. The co-operative sector has a long history in Nova Scotia. They operate a network of community owned financial institutions – credit unions. They know a thing or two about delivering services electronically. In many communities they are “the game changers” that the Ray Ivany report talked about. They are the ones standing up and saying “we can do this ourselves,” and, they are using their own cash (not government’s) to do it.
If the province had invested a fraction of that $11.5 million in a Nova Scotia company (let’s say one third or $3.5 million), it could have provided significant measurable results (reporting as one example), met their interoperability targets (more doctors using an EMR), created employment in the IT sector, and helped advance a NS export product.
The PHR prescription is working much the same. A U.S. company, McKesson, was chosen over a Nova Scotia company to do a pilot project with 5,000 patients (CBC Report, Feb. 11, 2014). The tender stated a budget of $400,000 but actual spending has already exceeded $1.1 million.
The same Nova Scotia company, Connecting People for Health offered to provide the PHR with a patient base of more than 600,000. This is the number of patients served in the clinics of 1,400 doctors (recall that is 70 per cent of all doctors in the province). This company has a fully functioning PHR ready to go, already being used by some patients. The province chose the U.S. giant over an existing local provider. In fact, it appears that the tender was written specifically for this outcome.
Why are we not asking have these investments been successful? Is the technology being used by doctors to help the majority of patients? Are clinics more advanced and efficient? Is it reducing wait times? Has it improved the working life of those providing the care? Can you show us real evidence that real improvements have been made in the quality of care provided?
And why not give a Nova Scotia company a chance? The department’s answer will likely be “they didn’t have the capacity”, but don’t buy it. That is nonsense. The capacity was there, and is still there, with a commitment and offer to prove that capacity by meeting of all of the department’s EMR and PHR standards, should such standards exist.
We have, yet again, swallowed another pill without question. Ray Ivany is right, changes in policy alone can’t fix these types of problems. We need a full on attitude adjustment.
We, the patients, doctors, other health providers and all taxpayers, can’t continue to swallow the pill and expect different results. We have to stop assuming that the Department of Health knows best. We need to be jumping in the streets about the ill effects and negative consequences of these decisions.
We need political leadership that is willing to support and encourage Nova Scotia game changers, rather than defending the old culture decisions (if it comes from away and has a big price tag it must be good for Nova Scotia).
It is indeed now or never for patients, care givers and physicians alike, an urgent call to action for all Nova Scotians; not just about our economy, but about our very personal health and well-being and that of our loved ones.
It is our time to Act.
Dianne Kelderman is the president and CEO of Connecting People for Health Co-operative Ltd and Medical Office Management systems.