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Joan Park, a case manager at Toronto's St. Michael's Hospital, sees herself as being on the leading edge of health care information technology.

In 2003, Ms. Park was part of a trial project for MEDcontinuum, a bit of software (also known as Clinical Utilization Management application) that tells nurses in charge of wards who needs a bed, who needs tests and who can be discharged.

Ever since, the software has become a handy tool to speed patients through the system.

"We have 535 beds, so space is always at a premium," says Ms. Park. "The system is great — not just because it lets us know what stage in treatment each patient is at with one glance at the monitor on the ward nurse's desk and what else needs to be done before discharge, but also because for the first time we have hard data on which to base our requests for more spending."

What it does not do, however, is involve patients themselves, she admits.

"We would like to, but there is still a paper-based system for that," she says.

St. Mike's is hardly alone in that respect, says Michael Martineau, director of Ottawa-based Branham Group's eHealth Practice. Branham does market research for the IT industry and in 2006 conducted an extensive look at the state of IT penetration in Canada's health system.

What Branham found would not surprise those on the front line of Canada's health care system. Canada's spending on health care-related IT lags woefully behind almost all other sectors of the economy, and despite trumpeting announcements of new, patient-centred software applications, few have actually been deployed.

In hospitals and clinics around the country, information and communications technology is a revolution still waiting to happen.

"We found that health care spent about $2.3-billion last year on IT, but that represents only about 2.2 per cent of hospital and other institutional operating budgets," Mr. Martineau says. "That is about half what banks spend right now."

"Personally I think people believe hospitals are much further ahead than they actually are," he adds.

Hospitals have followed a path of investment dictated by their own administrative needs, Mr. Martineau says. The first applications were designed to handle repetitive, staff-intensive back-office operations. Then money got spent on basic high-volume, data-rich support functions such as pharmacies, laboratories and medical imaging.

"Next in line was human resources functions," adds Dan Matlow, president and CEO of Medworxx Inc., the Toronto-based company that supplies 150 hospitals across North America with software platforms such as their Clinical Utilization Management software.

"It is only now, really, that hospitals are starting to spend on applications involving patient care and even then the money is going to those dealing with hot-button issues."

Moving patients in and out of limited numbers of beds is one of those hot-button issues, points out Ms. Park. The MEDcontinuum system is, in fact, surprisingly simple.

The software monitors a patient's stay at the hospital and highlights any potential bottlenecks in care giving and helps staff assess how ready a patient is to be discharged.

"Right now we have 69 patients waiting for beds to open up in rehabilitation facilities," Ms. Park says. "We can't discharge them because they have nowhere to go. That is a major problem with all hospitals today."

But again, while MEDcontinuum might fit more or less into patient-focused software, in effect, one of its major uses is to help convince hospital administrators and provincial funding agencies of the need for more investment in follow-up facilities such as rehab beds.

"That is part of its value," Ms. Park says. "We can now back up our demands for more funding with hard statistics."

Mr. Martineau suggests private industry would not long stand for the impediments that prevent much needed investment in IT. He sees three main factors slowing adoption in health care. It is not the availability of applications, he says. Branham's survey identified 304 major vendors in Canada, all focused on gaining a chunk of the health care market.

He ranks those factors as lack of funding, lack of trained people to install, maintain and operate the technology and the inability of the existing system to change to accommodate new technology.

"The result is worrying," he says. "For example, in diabetes management Canada ranks just sixth in the world for its effectiveness in managing a disease that is near epidemic levels in this country.

"The reason is that diabetics should get at least four different tests a year but half the patients don't get them because there is no electronic solution in place to ensure they do. They are not being recorded and tracked and then treated."

In an effort to grab the attention of hospital administrators, Medworxx recently introduced a program that can be used in situations such as epidemics, hurricanes or floods by notifying first- and second-line responders of what to do, when and where via an Internet portal.

"There has to be a sense of urgency involved today to get health care officials to spend," says Mr. Martineau.