2016 Engineering Technology
PEO York Chapter
Electronic Health Records
Mar 22, 2016
What’s it going to take for Ontario to have shared Electronic Health
Records for its citizens?
“By 2015, the electronic health record will facilitate the sharing of key
clinical data across the continuum of care while protecting the privacy
and confidentiality of the information. It will include patient and
provider registries that allow for unique identification of and
information on diagnostic images, laboratory test results, medication
profiles, hospital clinical reports, immunization history, and infectious
disease reports. The electronic health record will be accessible from
various points within a jurisdiction – acute care hospitals, ambulatory
clinics, community health centres, and physician offices – so that an
individual care giver, at a minimum, will be able to view a patient’s
record.” – Canada Health Infoway Mandate, 2000.
How’s Ontario Doing?
Client Registry ~ X We have 4. “Official” Client Registry only used by DI.
Provider Registry ~ X Exists but not used.
Diagnostic Imaging √ X We have a solid federated XDS implementation.
Lab Test Results ~ X Exists but barely used. Private players getting involved.
Medication Profiles ~ X Only ODB only in ED, but ambitious plans afoot
~ X Hospital Report Manager available in limited regions.
Immunization History X X Some municipal registries. Nothing provincial yet.
? ? (more of a public health thing)
eReferral X X
Why didn’t we make it?
And what’s it going to take to get there?
1. An Embarrassment of Riches
2. The last mile leads to a crumbling shack
systems ($20B to
•At least 12 different
EMRs, many small
wasn’t part of
About that $20B number…
• Perhaps should rethink the traditional monolithic Hospital System.
• Vancouver: $850M
• Toronto: $600M
• What if we separated repositories from workflow?
• Lower cost
• Open up to innovative workflow apps
• What about the cloud?
• Capital DIY -> Consumption model
3. Big Projects Fail
• Over 40% of North American IT projects budgeted at over $15M fail.
(Ontario’s Health IT ratio is worse.)
• Is it possible to develop EHR infrastructure in smaller, incremental
4. Give them an Inch…
• “If we had started with consumer access, consumer demand would
have forced faster progress on a shared EMR” – Eric Hoskins, Ontario
Minister of Health
• Requires patient “identity proofing” infrastructure
• Initial forays failed: Google Health, MS Health Vault. What makes us
think it will work this time?
5. Quality Metrics
• U.S. Meaningful Use offered carrots & sticks to promote data sharing
• Regional ACO model established business model for improved EHR
infrastructure to support improved outcomes at lower cost.
• Could a similar approach work here in Ontario?
What’s it going to take for Ontario to have shared
Electronic Health Records for its citizens?
1. Embarrassment of Riches: Many Agencies
2. Last Mile: Obsolete Hospital & Physician Office software
3. Big Projects Fail: Incremental options?
4. Give them an Inch: Patient Driven Demand
5. Quality Metrics: Incentives