Getting a Dialogue Started

The comments below from Dominic Covvey are posted as a starting point for a discussion on ehealth and where we find ourselves today in the rollout of electronic records at all levels (within physician’s offices, regional health authorities, provincial and national strategies). Several recent auditor generals’ reports - one on ehealth in Ontario (http://www.ehealthontario.on.ca/pdfs/News/AG_Report_en.pdf) and the other at the federal level on electronic health records and the role of CHI (http://www.oag-bvg.gc.ca/internet/docs/parl_oag_200911_04_e.pdf) provide background material for some of the concerns over consultants and their fees, accountability, achievement of targets, and the costs of implementing an EHR.

An initial human resources ‘sector scan’ undertaken jointly by CHIMA, COACH, ICTC and ITAC Health has also provided a snapshot of the number of qualified professionals in health informatics and health information management, or the ehealth workforce more generally, and shows there is both a skill shortage (available workers who need to upgrade skills to incorporate knowledge of health information technology and informatics) and a labor shortage (a general lack and availability of skilled ehealth workers) (https://www.echima.ca/media/documents/HIHIM_report_E_web.pdf). The latter study concludes that “There is a serious risk that labour shortages and skills shortages will constrain the successful implementation of EHIS technologies in Canada…System-based, human resources planning measures should be a priority to ensure that the substantial investments that governments at all levels are making in EHIS technologies deliver the promised benefits.”

I have provided links to these documents and Dominic Covvey’s comments to get the dialogue started. What are the problems and more importantly how can we address them? We hope that this blog will form a forum for discussion, commentary, sharing of ideas, and feedback.

“Related to what some have termed the “ehealth debacle”, I am sure that there are at least as many opinions regarding causal factors as there are people opining. However, an understanding of our situation and what we are trying to do through ehealth certainly leads to some reasonable hypotheses about why things are not entirely copacetic. Consider the following possibilities: (1) the lack, or inadequate quality, of oversight, (2) less than full accountability, (3) the sometimes ‘bum’s rush’ to get ehealth projects underway and get EHR components in place…although perhaps not always the right components given true needs, (4) the ‘fire hose’ of funding from which only consultants seem to be able to drink, (5) the absence or weakness of the business case for, and of the evidence of the proven value of, ehealth with the consequent challenge of deciding in what to invest, how much, and what’s enough, (6) the reticence to recognize the magnitude of the ehealth challenge and what we will need to invest to realize our dreams, and (7) the dearth of fully qualified ehealth professionals. I personally believe that each of these contributes to the current embarrassing situation. A perhaps very important factor is that we have not yet recognized the magnitude and dimensionality of the challenges we face…in other words, we don’t, or aren’t willing, to fully comprehend the problem we are confronting.”