Doctors wary of going online
Paper still reigns in most MDs’ offices Security, cost, time are digital issues
Dr. Joe Boorany runs a typical doctor’s office. Patient files are collected in folders and stored in cabinets. Referrals and lab results are relayed mostly by fax machine, while lab images and hospital reports are most often received through mail and courier.
Like an estimated 98 per cent of doctors’ offices in Ontario, paper remains king and electronic health records rarely emerge as a topic of conversation. “ To my knowledge they’re not widely used,” says Boorany, who has been a general physician for 25 years and is associated with Humber River Regional Hospital. “ I haven’t heard anybody talk about it.”
Getting doctors such as Boorany to embrace digital records in their offices is a challenge the health ministry grappled with for many years. The province’s answer under the previous Conservative government was the creation of the ePhysician Project, an ambitious initiative designed to encourage doctors to go digital, get online and electronically interact with hospitals, labs, and other health- care providers. The carrot? A combination of free online services, technology support and a $ 150 million fund to subsidize their hardware and software purchases.
That money was announced in the April 2000 budget, and the ministry, in collaboration with Smart Systems and the Ontario Medical Association, began hiring consultants and testing technologies, including “ clinical management system” software that doctors might use to create and manage patient health, scheduling and billing records. A key component of that software would be a pay- per- month version that would be centrally hosted and maintained on Smart Systems’ network. The idea is that doctors who don’t want to go through the hassle of purchasing and installing their own clinical management software can simply subscribe to an online model that is accessed through the Internet. Under this approach, patient information would be stored and protected by Smart Systems’ in a central data centre instead of locally on a doctor’s own computer systems. The ePhysician Project also called for the creation of a passwordWeb portal – since called OntarioMD.ca – that would offer all doctors secure e- mail for sending and receiving patient information, as well as provide access to a drug database, medical journals, the latest studies and other educational material. But from the start, the effort has been dogged by controversy. Some doctors suspected the government would be tempted to peek into the planned system to perform secret electronic audits. Others saw early signs of nepotism when David Pattenden Jr., son of then OMA chief executive David Pattenden, was hired as a main consultant on the project. The technology community had its own trepidation — a sense that the government was hand- selecting the type of software systems that doctors should use.
“ Governments have never been good at picking winners and monopolies are never in the best interest of public procurement,” says John Soloninka, president of Toronto- based Cogient Corp., a provider of healthcare software that has followed the ePhysician Project from its inception.
There was also concern that the OMA, which set up an independent subsidiary called OMA eServices Inc. to manage the program as part of a deal with the ministry, was gaining too much power as a gatekeeper of the Web portal. What would prevent the tracking of doctors’ surfing habits, prescriptions, and other information that could be sold or shared for profit? Sources say the OMA flirted with the idea.
“I think doctors in general have found the whole idea rather daunting,” says Dr. Douglas Mark, a family physician and president of the Coalition of Ontario Family Physicians. “ After years of difficult contract negotiations, I think doctors will be very leery about anything from government and the association.” Mark said part of the problem is that development of the program was kept at such a high level that the consultants and others heading up the project were too far detached from the needs of doctors. “ There’s been very little contact,” he says. Money was also slow to flow. Smitherman, who became health minister in late 2003 when the McGuinty government came to power, says he was surprised to learn that the funds for the project committed back in 2000 had yet to be paid out.
“ In other words, I arrived here and it was a goddamn huge irritant that the dollars had not been flowed,” he told the Star. “ Associated with this always has been broad and understood objectives with respect to what (the OMA) was supposed to achieve. It’s been slower in development than anybody would prefer.” The OMA finally got $ 128 million of the promised funds last September, three months after OntarioMD. ca was supposed to launch to 25,000 physicians across the province. The OMA never made that June 2004 deadline. It is now telling doctors they’ll have to wait until 2006 before they can get access to the portal. The same goes for the clinical management software meant to handle electronic health records. After on- and- off negotiations over the past two years, OMA e- Services Inc. and Smart Systems’ just announced last month that they’ve signed a 15year contract with GE Healthcare, a division of General Electric, to supply the subscriptionbased digital records software.
Halifax- based xwave Inc., the computer services arm of East Coast phone giant Aliant Inc., has customized the GE software for the Canadian market. It was the same company hired to design the OntarioMD. ca portal. Afew hundred doctors are now testing the technologies. The OMA says about $ 14 million has so far been spent developing the software and training and supporting those test physicians. The money also went toward the Web portal, which has already gone through two redesigns. Of $ 114 million left over, about $90 million has been set aside to subsidize physicians who purchase the required software and hardware. What will happen with the remaining $24 million is “ yet to be determined,” say OMA spokesperson Patrick Nelson. Greg Flynn, president of the OMA, says he expects about 1,000 doctors in the province to begin using the software and accessing the portal next year. “ That should amount to about 1.5 million patients reaping the benefit,” says Flynn, adding that the money received from the ministry so far is only enough to support about 3,000 doctors in total. To get all doctors on board, it will cost the province between $ 1.5 billion to $2 billion, he says, adding that the ePhysician Project is just the first major step of a long- term strategy. “ The amount of money we’re talking about is maybe 10 per cent of what it would cost to really provide the infrastructure for all doctors in the province.”