The Romanov Report: Electronic Health Records, Research Paper Example

The healthcare system in Canada, called Medicare, is a government-funded universal health insurance program that was formed by various laws that were enacted in 1957, 1966, and 1984.  Globally, Canada is well known for its socialized health care system which is frequently held up as a model for successful medical treatment, and has been widely discussed during the period of healthcare reform in the United States.  The “father” of the health care system is considered to be Tommy Douglas, whose reforms in 1947 in Saskatchewan Province initiated the drive towards a national publicly funded health care system (Steiner, 2009.) Eventually, this led to the Romanow Report, a comprehensive overview of the healthcare system which culminated in 47 recommendations with the goal of fixing and sustaining the existing system.  This paper will provide a discussion of the context in which the Romanow Report evolved, and will specifically discuss a group of recommendations pertaining to the use of electronic medical records in the system.

Health care in Canada became free in 1947, when Premier Tommy Douglas enacted the Saskatchewan Hospitalization Act; one decade later, Prime Minister Louis Saint Laurent introduced a National Hospital Insurance Program that was met by loud opposition from physicians and insurance companies (Steiner, 2009.) In 1962, the New Democratic Party, or NDP, in Saskatchewan introduced the first Medicare program which resulted in doctors in Canada going on strike for a period of three weeks.  The result was an agreement that the doctors would be charged with making decisions about healthcare spending.  Four years later, the national government of Canada established a Federal Medicare program, agreeing to pay for 1/2 of the costs.  Later on, the Trudeau administration changed the structure of the program to provide block funding, allowing the provinces to exert more control over their own programs.  Early in the 1980s, the Canadian Health Coalition required that the healthcare system be free and not-for-profit, comprehensive, universal, portable, and accessible.  The Canadian Parliament unanimously approved this plan in 1984 (Steiner, 2009.)

The evolution of the Canadian healthcare system produced rising costs for hospital and medical services.  On one hand, many leading citizens, health care professionals and politicians insisted that healthcare was a social good, not simply another material commodity.  This perspective was opposed by people who felt that individuals should take responsibility for their own and their families’ healthcare needs through private insurance plans.  This point of view held that governments should underwrite the costs only for those who could not afford such benefits (Making Medicare: The History of Healthcare in Canada, 1914-2007, 2010). This was in contrast to the United States, where Medicare is restricted to the elderly; the Canadian plan provides universal coverage for all citizens and permanent residents, allowing then to access health services throughout the country and when they travel or move between provinces.

In 2002, an extensive evaluation of the Canadian health care system was conducted, with the results appearing in a formal report released by the Romanow Commission.  A total of 47 recommendations were included in the conclusions of the report.  The following recommendations, eight through 13, involved maintaining electronic health records for each citizen:

• Recommendation 8: A personal electronic health record for each Canadian that builds up- on the work currently underway in provinces and territories.
• Recommendation 9: Canada Health Infoway should continue to take the lead on this initiative and be responsible for developing a pan-Canada electronic health record framework built upon provincial systems, including ensuring the interoperability of current electronic health information systems and addressing issues such as security standards and harmonizing privacy policies.
• Recommendation 10: Individual Canadians should have ownership over their personal health information, ready access to their personal health records, clear protection of the privacy of their health records, and better access to comprehensive and credible information about health, healthcare and the health system.
• Recommendation 11: Amendments should be made to the Criminal Codes of Canada to protect Canadians’ privacy and to explicitly prevent the abuse or misuse of personal health information, with violations in this area considered a criminal offense.
• Recommendation 12: Canada Health Infoway should support health literacy by developing and maintaining an electronic health information base to link patients to health information that is properly researched, trustworthy and credible as well as support more widespread efforts to promote good health.
• Recommendation 13: The Health Council of Canada should take action to streamline technology assessment in Canada, increase the effectiveness, efficiency and scope of technology assessment, and enhance the use of this assessment in guiding decisions (Romanov, 2002.)

The above recommendations were particularly pertinent to the Canadian healthcare system since paper records were becoming increasingly inadequate and obsolete.  They limited the flow of information, and were ineffective in documenting patient care, presented obstacles to the integration of healthcare delivery, created obstacles to research, and put limits on the data available for administration and decision-making.  An inordinate amount of time forced healthcare providers to spend upgrading and managing paper records.  It was strongly believed that instead of spending the time that healthcare professionals did working on charts, they could rather be spending that time on providing direct service healthcare delivery to patients  (The Romanov Report and Informatics, 2001).

Medical records had been stored as paper files in the doctor’s office, where they had become the official property of the physician.  More recently, it has come to be understood that both the doctor. and his or her patient rightly own the information together and that each party is entitled to control the access by third parties such as insurance companies.  Originally, the medical record was virtually an account of what had happened at each meeting between the physician and the patient.  Each visit produced more notes.  Eventually, the notes would become summarized into an account of any particular illness; the record would also include hospital discharge summaries, treatment methods, and lab test results When the doctor was out of the office for one reason or another, a covering physician would insert interim notes, and the files would also frequently contain consultation letters.  Insurance reports would then be added to the file as well as an endless stream of paper.  Eventually, specializations led to distinct records being kept in separate offices (Flegel, 2008.)

In contrast to maintaining paper records, there are many advantages to maintaining electronic health  records.  As a result, the recognition of this fact resulted in nearly universal support for the idea of such record-keeping.  The benefits of maintaining electronic health records include: diagnosis, treatment and results can be maximized when physicians and other healthcare providers are able to access a patient’s complete personal health information and can connect that data to clinical support tools, resulting in quality of care; correctness of personal health records could be improved because data from many healthcare providers is accumulated and stored in a single record, which provides a more thorough  and accurate account of a person’s personal health history; efficiency could be upgraded by reducing the amount of time spent by staff updating paper records; electronic health records contain valuable information that can be used for research, in health monitoring , following disease trends in keeping tabs on the health status of Canadians; in addition, privacy would be improved since legitimate access to health  records would require precautions to be enacted in order to guarantee the confidentiality of such information for patients (The Romanov Report and Informatics, 2001).

For individual Canadians, a system of electronic health records provides substantial benefits.  Citizens would have secure on-line access to their personal health record, as well as access to a broader base of general information on health issues.  This permits them to play an active role in making healthcare decisions and increases the ability to self-advocate.  Health care providers also benefit from electronic health records since they have access to clinical decision support tools to help them in making decisions regarding their patients, and using information that is the most updated and pertinent available at that time.  Additionally, they have an immediate access to a patient’s information when they  meet with someone seeking help, and it would be an important tool in helping doctors manage the tremendous amount of complicated health information that is relevant in treating people.

Another population to benefit from electronic medical records are researchers and policy makers who would have the ability to access collections of information to be utilized for healthcare research purposes, while preserving the privacy of individuals’ health records.  The healthcare system would be mandated to take significant steps to safeguard the privacy and identity of individuals if researchers need to have access to more personal data regarding patients.  This would be one way of monitoring and measuring treatment outcomes and permitting an increase in healthcare monitoring while managing the treatment of specific diseases, especially chronic illnesses  (The Romanov Report and Informatics, 2001) .

Utilizing electronic medical records could be an important factor in improving the overall quality of the healthcare system.  Such  record-keeping would increase the ability of healthcare  providers and researchers to target and respond to medical mistakes or dilemmas that are built into the system, improving patient  safety and quality of care.  Without this technology, it is difficult, if not impossible, to track such problems, and possibly the motivation to do so or not is affected by the fear of blame and being sued for malpractice  (The Romanov Report and Informatics, 2001).

The Canadian government has demonstrated its support of the Romanow Report recommendations for the implementation of electronic health records by including $500 million in its 2009 Federal budget to continue to enable the process (Infoway, 2009.) Such a massive amount of funding was intended to allow the EHR system to extend to every province and  territory in an effort to improve patient safety, cost saving, and increased clinical efficiency.  In addition, the funding was intended to create thousands of jobs throughout Canada’s health and information technology industries  (EHR: Advancing Canada’s Next Generation of Healthcare, 2000). That infusion of money caused the total amount invested in the electronic health records system to reach $2.1 billion since its inception.

In fact, a not-for-profit organization that has been set up to administer the electronic health record system in Canada is Canada Health Infoway, an independent organization that is completely funded by the government.  Infoway joins with each province and territory to speed up the adoption of electronic health record projects throughout Canada.  However, despite the best intentions to change over to a new system, as of 2009, the vast majority of medical records in Canada were still handwritten notes, despite the fact that Canadians are great users of their healthcare system and the time and cost saving benefits of implementing the EMR system are clear  (Digitizing Health Care: Electronic Health Records: Potholes on the Road to E-health, 2009). Infoway has received $2 billion for the purpose of overhauling the nation’s healthcare records.  Despite the fact that Infoway’s goal is to provide electronic health records for all Canadian citizens by the year 2016, to date, only 5% of records are electronic.  However, the agency predicts that half of their health records will become electronic by the end of 2010. (Buckler, 2008.) In addition, according to a Commonwealth Fund study conducted in 2007, only 23% of Canadian physicians are using some form of electronic medical record-keeping.  That is in comparison with 98% in the Netherlands, 92% in New Zealand, 89% in the UK, and 79% in Australia.  (Buckler, 2008.)

What accounts for such a poor performance in transitioning to EMR?  Some officials attribute the lack of success to a lack of government attention to information technology in healthcare.  Richard Alvarez, the CEO of Infoway, feels that IT has been the” poor cousin” in healthcare funding in Canada.  Changing the records in all doctors’ offices, clinics, hospitals and laboratories across Canada will cost about $10 billion, which, he acknowledges, sounds expensive but he believes that the savings that would result from that automation of records could reach between $6 and $7 billion annually (Buckler, 2008.)

Despite this lag in operating a new system, public opinion in Canada runs high when it comes to having a preference for electronic health records.  According to surveys, 87% of Canadians believe that electronic health records will mean quicker and more accurate diagnoses, and 82% believe that they will reduce errors in prescriptions (Buckler, 2008.) While there is no question that digitizing health records would be costly and time-consuming, in the long run, it would save both time and money.  Rather than hand writing notes, health care providers would be able to convert that time that had been previously used for such laborious work into direct service hours for patients.  It would also save time for the doctors’ staffs, which might not have to spend as much time looking up records to answer questions for patients if their patients were able to access their records on-line.  In addition, privacy issues could be greatly improved if access to electronic records was carefully guarded so that it was only available to a specific person or persons who are able to access it with a password and username.  Although switching over to this new system is certainly not an easy task, it seems clear that the benefits of doing so would far outweigh the drawbacks of continuing with a paper-based system of record-keeping.  In the future, medical practices, clinics, and hospitals that begin using electronic medical record-keeping will not have to switch over because the starting point, for them, will already be an efficient system.

In conclusion, the Romanow Report contained a great many worthwhile recommendations and included among them are certainly those pertaining to the implementation of electronic health records.  The sooner that Canada is able to convert to this system, the more easily it will operate.

References

Buckler, G. (2008, January 28). Health Records: Canada Lags in Electronic Medical Records. Retrieved January 29, 2011, from CBC News: http://www.cbc.ca/news/background/healthcare/records.html

Digitizing Health Care: Electronic Health Records: Potholes on the Road to E-health. (2009, May 27). Retrieved January 29, 2011, from CBC News: http://www.cbc.ca/health/story/2009/05/27/f-electronic-health-records.html

EHR: Advancing Canada’s Next Generation of Healthcare. (2000). Retrieved January 29, 2011, from Canada Health Infoway: https://www2.infoway-inforoute.ca/Documents/Vision_2015_Advancing_Canadas_next_generation_of_healthcare%5B1%5D.pdf

Flegel, K. (2008, February 26). Getting to the Electronic Medical Record. Retrieved January 29, 2011, from Canadian Medical Association Journal: http://www.cmaj.ca/cgi/content/full/178/5/531

History of Canadian Electronic Medical Records Timeline. (n.d.). Retrieved January 29, 2011, from Google: http://www.google.com/search?q=History+of+++Canadian+Electronic+Medical+records+&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a#q=History+of+++Canadian+Electronic+Medical+records&hl=en&client=firefox-a&hs=vdt&rls=org.mozilla:en-US:

Making Medicare: The History of Healthcare in Canada, 1914-2007. (2010, April 22). Retrieved January 29, 2011, from Online Exhibition: http://www.civilization.ca/cmc/exhibitions/hist/medicare/medic01e.shtml

Romanov, R. J. (2002, November). Building of Values: the Future of Healthcare in Canada. Retrieved January 29, 2011, from Commission on the Future of Healthcare in Canada: http://dsp-psd.pwgsc.gc.ca/Collection/CP32-85-2002E.pdf

Steiner, L. (2009, August 19). Structure and History of Canadian Healthcare. Retrieved January 29, 2011, from Suite 101: http://www.suite101.com/content/structure-and-history-of-canadian-healthcare-a140671

The Romanov Report and Informatics. (2001, April 4). Retrieved January 29, 2011, from PDA Cortex: http://www.pdacortex.com/romanow_report.htm