Paul MacNeill

Somewhere in the bowels of both the QEII and IWK Hospitals sit single computers that Health PEI believe offer ready access to necessary information on Island patients transferred to Halifax for treatment.

Health PEI is wrong. What these two solitary computers actually represent is the folly of Island governments in spending upward of $100 million (no one is really sure exactly how much in federal and provincial money we’ve spent) on an electronic health record system that doesn’t play well with our neighbours.

Way back in the waning days of the Binns government, then Health Minister Chester Gillan proudly announced a made in PEI electronic health care record he promised would cost $13 million and be in full operation in 15 months. Thirteen years later and we still do not have an Island-wide solution. Nor is there courage to look beyond the limits of the silo created by narrow minded bureaucratic thinking and timid political leadership to find a solution that actually works for patients.

Health PEI has never promoted the computers that sit in unknown rooms of Halifax hospitals. Islanders only learned of their existence via a tweet from a former CEO of Health PEI, Dr Richard Wedge, who I enjoyed a minor Twitter skirmish with last week. Dr Wedge used the information to correct a suggestion of mine that our electronic health records do not work in other provinces.

Rather than prove his point, Dr Wedge’s defense only shows what’s wrong when a bureaucracy forgets the people it is supposed to serve. Health PEI’s Band-Aid solution imposes an inordinate amount of extra work on Nova Scotia physicians. First they must know the computer exists, not guaranteed given the often transient nature of medical care. Then they must find the computer, not guaranteed given the physical size of the hospitals. Then they must hope the computers are working and there isn’t a lineup, not guaranteed given how closely the PEI and Nova Scotia systems are intertwined.

All the while, the patient is waiting. Let’s hope it’s not an emergency.

Where is the Health PEI analysis that two computers in Halifax will have a positive impact on health outcomes? It’s likely there is none because electronic records are only as good as the system they are implemented in. And our system doesn’t work in Nova Scotia or New Brunswick, where we spend a combined tens of millions of dollars annually.

There is a growing mountain of independent data showing a link between electronic health record implementation and physician burnout. One look at PEI and you can see why.

Outside of our own facilities, Nova Scotia is by far the largest deliverer of health care to Island residents. Documents show Islanders spent $65 million for services in Nova Scotia between 2014-2016, or roughly 10 per cent of all Health PEI vendor costs. (By comparison providing ambulance coverage to PEI during the same period cost less than half).

That’s a lot of out-of-province service to not provide ready access to our electronic records. And Health PEI’s ‘solution’ doesn’t even deal with New Brunswick, the second largest provider of health care to Islanders at a cost of more than $10 million per year. You guessed it, no Island computers are stuck in New Brunswick hospital cubbyholes.

What started all of this was a statement by current Health and Wellness Minister James Aylward that it’s time to deliver electronic records to physician offices. What Aylward didn’t say is the option to deliver this module has always been in place, but physicians refuse to pay the high cost demanded by Cerner, the American corporation chosen way back when to deliver a Cadillac made in PEI solution. Island taxpayers pay Cerner more than $4 million annually, just to cover basic costs of our system.

Aylward has stumbled since becoming minister, a combination of a tough portfolio and an entrenched bureaucracy. If he wants to be effective, he must be the driver of change and electronic health records is a perfect place to start. Nova Scotia is in the process of half billion dollar project to develop a single health record. The process is not without controversy, including that Cerner is one of two corporations to receive what is referred to as unfair favouritism from the Nova Scotia government. There are also questions about data collection.

But this does not mean it can’t, or should not, happen. It’s not rocket science; it’s common sense. Our systems are interconnected at the patient level, but stuck in reverse gear because of parochial bureaucrat whims and silos. If Nova Scotia and PEI can agree, others will follow because silos don’t make for good health care.

James Aylward can be a needed agent of change. Or he can add his name to the long list of health ministers to wilfully ignore the obvious. Let’s hope he opts for the heavy lifting necessary to improve the system for patients – starting with getting rid of two lonely computers in Halifax.

Paul MacNeill is Publisher of Island Press Limited. He can be contacted at paul@peicanada.com

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