Technology put a man on the moon but in Nova Scotia (and several other provinces) efforts to computerize a patient’s medical history continue to confound and disappoint despite the expenditure of tens of millions of dollars.
Last week, Health Minister Randy Delorey was forced to announce the company which for the past three years had been providing family doctors and patients in Nova Scotia with an online portal to access test results for X-rays, MRIs, blood tests, and the like was pulling the plug.
Delorey said the withdrawal was “a business decision” by McKesson Canada, which had developed and implemented the MyHealthNS software.
The portal also allowed patients to book an appointment with their doctor and communicate directly by email, much the same way people do with their hairdresser or their lawyer.
There were no reported privacy or security issues with MyHealthNS. My family doctor was signed up and so was I. Test results arrived on my laptop without incident. In fact, 35 family doctors had participated in a pilot project three years earlier (2012-2015) before Ottawa came onboard with $10 million and the province added $3 million to roll it out across Nova Scotia. Minister Delorey told reporters Thursday only about $8.5 million had actually been spent and McKesson received about $4.5 million.
So what went wrong?
Clearly the uptake by family physicians and patients after three years of piloting and three years after the launch in 2016 was underwhelming. Only 300 family doctors and 30,000 patients were using the online system. There are about 1,100 licensed family docs in the province so only about 27% were using it.
Andrew Forgione with McKesson Canada confirmed the uptake was one factor in the company’s decision not to renew its business with the province after it had fulfilled the terms of its three-year contract. Forgione said McKesson spent “millions” developing the system which was not installed by any other province. He says the company has committed to serving the existing doctors and patients in Nova Scotia until the Department of Health hires a new service provider.
A study released by the Canadian Medical Association this week found an overwhelming majority of Canadians (75%) want to have a secure, personal electronic health record that travels with them and could reduce potential clinical errors.
So why didn’t more Nova Scotian doctors sign on?
Dr.Gerard MacDonald chairs the IT steering committee for Doctors Nova Scotia. “The integration has not been super-tight,” says MacDonald, with what sounds like masterful understatement. “While we have some disappointment with the fact the MyHealthNS portal is going to be phased out, I think it is a tremendous opportunity to look at newer products that may have much tighter integration with our medical records.”
MacDonald says one important factor in why more doctors didn’t embrace MyHealthNS was the new software wasn’t integrated with a separate, electronic medical record-keeping program used by 85% of family doctors. The EMR system in their offices is used to schedule patients, bill patients, and maintain their medical and prescription history.
MacDonald says that EMR system originally provided by Nightingale and purchased by a subsequent company was in the process of being phased out in 2016 when the Department of Health launched MyHealthNS. Bad timing. MacDonald claims the uncertainty and anxiety around what would replace their critical electronic record-keeping software in the office left many physicians disinterested in implementing another electronic portal to communicate with patients. Yet another portal allows doctors to view X-ray images of their patients.
Another major factor that contributed to the slow adoption by doctors of the online patient communication technology was money. It wasn’t until last summer, 2018, that the province agreed to compensate family doctors for time spent posting test results, making phone calls, and communicating with patients by email. The 300 family docs who installed and use MyHealth NS now receive $12,000 each year as an incentive to keep using it. They will continue to receive that even though the government can’t expand the program by allowing more doctors to register until a new service provider can be found.
“In terms of the big picture and access to your medication history or to other health-care providers like physiotherapists, that wasn’t there with MyHealthNS,” explains Dr. MacDonald. “That will have to wait for the next iteration of One Patient, One Record (OPOR).”
OPOR is supposed to merge diagnostic test results as well as list prescription drugs and information about visits to the family doctor and other specialists in one secure, personal file. It’s the Holy Grail of electronic health records for both patients and physicians (including specialists who aren’t part of the incentive program) that could go a long way to reducing clinical errors and improving care, particularly for people entering nursing homes who usually have had multiple and complex interactions with the medical system.
“If we can get an integrated electronic health record that acts as a single repository for health care across Nova Scotia, that could change health care delivery,” said Dr. Tim Holland last December 2018 when he was president of Doctors Nova Scotia.
But despite decades and tens of millions of dollars of federal funding through various Pathways and Information Highway projects, in this province there is still no timeline for OPOR’s eventual implementation. The Department of Health is still bogged down choosing a service provider between short-listed Cerna and Allscripts as a result of allegations of favouritism from a losing bidder in Alabama called Evident.
That vacuum is another reason why Dr. Gerard MacDonald thinks it is still worth trying to engage family doctors and patients in supporting the next generation of MyHealthNS. He thinks the Nova Scotia Department of Health is making the right move to look for a new provider willing to encourage more doctors and patients to sign on, limited though the service is.
“I still think we need to have a patient portal so they can access their information,” says MacDonald. “The public demands this. We need to do a better job in engaging physicians. The ideal patient portal would be seamless and integrated within one electronic medical record and that way the doctor can go to just one portal. Doctors Nova Scotia continues to strongly support patient portals in whatever iteration.”
After 40 years in practice as an Eye, Ear & Throat surgeon in the Amherst area, MacDonald is convinced patients want and deserve better “virtual” health care. He says he is “optimistic” that will happen but he won’t predict when or how much taxpayer money it will cost to get there.
“It’s challenging and health care has tended to lag behind other sectors,” he notes.
It ain’t just Nova Scotia, so the Examiner’s usual explanation for policies it dislikes, that NS civic leaders, politicians, and bureaucrats are horse’s asses, won’t suffice.
Adoption of EMR has been frustratingly glacial throughout North America.
It’s 2019 and I still have to get a paper requisition for blood tests, I have to hold on the phone for a doctor’s appointment, and my doctor can’t integrate her records with those of various specialists.
Meanwhile, I can book a hotel from my phone and have it appear in a separate calendar application with ZERO input from me.
Integration isn’t difficult. Get it done and let’s move into the twentieth century.