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.

To shed some light on what this means for Canada, we took at look at OECD’s data on national health expenditures and life expectancy at birth. We got the idea from The Baseline Scenario.

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.

This month, students at Algonquin College developed, tested and installed the first reminder application to use Cliniconex for Developers. The application, being evaluated at Algonquin Health Services, takes appointment reports from an Electronic Medical Records (EMR) system and then uses the Cliniconex for Developers API to initiate voice reminders via the remote Cliniconex Core Application.

As part of a 3-month project class, the team of Robin Murphy, Long Huo, Junxian (Pam) Li, Juanita Stairs, Yong Lian (William) Zhu took about 40 hours to develop the application and a couple of weeks to test it. They also delivered project documentation as well as a superb user manual.

The application has two buttons – one to point to an appointment report created by Practice Solutions, the EMR used at Health Services, and one to initiate processing. How’s that for a simple user experience?  One of the reasons the interface can stay simple is that error handling is done by the Cliniconex Core App, which ensures error conditions, such as re-processing the same report, are handled properly.

It’s pretty effective, too. At the training session with the clinic, the receptionists were excited to see appointments confirmed in the time it took them to run the application and then log into the Cliniconex Core App to look at the call reports.

Algonquin Student Reminder App’s Two-Button Interface

The team garnered a great final mark and some fine reviews from the clinic staff. They also showed how easy it was to use Cliniconex for Developers to deliver real life reminders in a live situation.

Thanks to the Algonquin Research and Innovation program for their help in getting this project going, especially John Omura who scouted potential users for us; Professor Mel Sanschagrin who supervised the team; and Wayne McIntyre, director, and Cathy Trueman, clinic manager, at Algonquin Health Services for their support.