Recently, the U.K.’s centralized electronic health record program was acknowledged to have failed in its entirety and was scrapped. Introduced in 2005, the £12 billion (about $20 billion CAD) program was created to move the U.K. health care system toward a single, centrally-mandated EHR. In what has been called the largest civilian IT project ever, the program has been criticized as being a waste of taxpayer’s money and failing in its core objectives. With their government facing severe fiscal limits, U.K. taxpayers could no longer afford to take a “wait-and-see” approach.
First of all, most of the data is relative to the OECD median life expectancy or health spending. The exception is the OECD trend, which is absolute and shows that over the period, OECD countries spent more and gained longer life expectancy. So, in absolute terms, the median is drifting upwards towards the right.
If a country stays clustered around the zero crossing for the axes (where the OECD median is), that country’s health expenditures are rising and health is improving for the population. This is the case for the U.K. Their relative expenditures increased earlier but then drove aggressively back towards the OECD median. When money becomes tight, programs get cut. With about two-thirds of the IT program’s multi-billion dollar cost already spent and no foreseeable end in sight, the long-criticized NHS program was an easy target. The proposed alternative is to favour cheaper regional options chosen by the hospitals and GPs.
So here’s the thing for Canada. We’re in much better fiscal shape than the U.K., having escaped relatively unscathed from the latest recession. So we may be able to afford a little more time with our healthcare IT projects. Given current world economic stress, it might be inevitable that our healthcare spending will be aggressively driven back towards the OECD median.
The warning signs are there that Canada’s EHR initiatives could be likely targets. As the April 2010 Auditor General’s report points out, there have been modest advancements made, but not without significant criticism. In what has been painted as a “dismal” picture, the initiative has taken flak for its comprehensive plans that are depicted as muddled, uncoordinated, and loosely interpreted by individual provinces. While some provinces have seen more centralized EHR development than others (I.e. Alberta’s Netcare EHR), there is a long road ahead to reach the goal of pan-Canadian interoperability. Questions of timing, quantifiable progress, compatibility, benefits, and ultimate costs are burdening the initiative.
Infoway’s EHR effort needs to show progress and achieve stated outcomes. And it needs to do it quickly. As U.K. health care has shown us, there isn’t time for the “wait-and-see” approach. Canada needs quantifiable results in the short-term, or the program will become a leading candidate for future budget cuts.