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For health's sake, trash those paper records

One of the most poignantly pathetic images in health care is that of the patient lying on a gurney in a hospital hallway in a paper gown, bare bottom hanging out.

Nobody looks good in paper.

Same goes for health systems: None of them look good when they are dependent on paper records.

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Health care institutions and health practitioners who are still using paper medical records rather than electronic ones are much like those people with their behinds hanging out: vulnerable and undignified, and the very thought of them should leave us embarrassed and ashamed.

Good information is a prerequisite to good care but, in Canada, we are e-health laggards.

"Information technology that has revolutionized every other aspect of our lives is painfully absent from the way we manage and share health information," says Richard Alvarez, president and chief executive officer of Canada Health Infoway, a non-profit group that is pushing to make electronic health records a reality in Canada.

Banks, video stores, pizza parlours, taxi companies, couriers, bus systems and newspapers are all light years ahead of health institutions when it comes to electronic recordkeeping and information management.

Yet one would be hard-pressed to think of a part of society where better access to information would be more welcome.

After all, in health care, lives can literally hang in the balance based on the quality of information and the speed at which it can be accessed.

Each year in Canada, more than 100 million physician exams and 500 million laboratory and radiology tests are performed, and 382 million prescriptions are written.

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These data are scattered and largely inaccessible in thousands of doctors' offices, health clinics, test centres, laboratories and hospitals.

Right now, fewer than one in four doctors use electronic medical records. (The computers you see in their offices are often used strictly for billing purposes.) Even fewer nurses have personal digital assistants or laptops at the bedside.

Most hospitals have some form of electronic recordkeeping but, more often than not, these systems are not compatible or integrated.

When a patient is admitted to hospital, records are often faxed from the physician's office; when a general practitioner refers a patient to a specialist, the appointment tends to be made by phone; an estimated 10 to 20 per cent of tests have to be redone because the results are misplaced; patients must travel far afield to see a radiologist instead of e-mailing their scans; care of patients with complex chronic illnesses is rarely co-ordinated, because doctors keep separate records; when patients are transferred from hospital to home care, or from home care to a long-term care facility, there is rarely any continuity in recordkeeping. This old-fashioned way of doing business is intolerable.

"Simply put, the right information must be available to the right health care provider at the right time," Mr. Alvarez says. "Anything less is unacceptable and it's dangerous."

E-health is not a panacea, but it will provide opportunities to improve efficiency and care.

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Ottawa and the provinces have agreed to create electronic records for half of all Canadians by 2010 and 100-per-cent coverage by 2020. But that's not near fast enough.

Just as we can access money at every bank machine in the country, so too should our electronic medical records be accessible to all health professionals we consult, from the pharmacist close to home through to the emergency room and the other end of the country. (With the requisite protection of privacy, of course.)

It's not enough to create health records; it must be done right. That means including information on visits to physicians, hospital stays, prescription drugs, laboratory and radiology tests, immunization, allergies, family history and so on. It also means integrating all these records and making them compatible in every jurisdiction - admittedly no small feat.

All this takes money. Lots of money. Let's not pretend otherwise. But let's recognize too that this is a wise and necessary investment.

So far, Canada has invested about $40 a person on e-health. This is far too little for the task at hand.

A couple of recent studies have estimated that getting the job done requires about $350 a person over 10 years or about $12-billion in total.

That works out to about $35 annually a person - a trifling amount when you consider that per capita health spending last year was $4,548.

It's time to get our health system out of that flimsy paper robe and into a new electronic garb, because the unseemly cracks in the system are really beginning to show.

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