BY NORM TOLLINSKY

Someday in the not too distant future, hospital emergency room staff will be able to access everything they need to know about a patient’s medical history, the medications he’s on, his lab tests and diagnostic images prior to commencing treatment.

The patient could be a resident of Toronto admitted to Sudbury Regional Hospital following a car crash on Highway 69, or a Soo Greyhounds forward who collapses after a bone-crushing check during a hockey game in Kitchener. In the grander, national vision, emergency medical personnel across the country would be able to access the medical records of every Canadian, regardless of the patient’s home province.

Getting there may take another decade, but the journey is well under way.

In Ontario, responsibility for making it all happen falls to the provincially funded Smart Systems for Health Agency (SSHA).

Established in 2003, SSHA has a mandate for transforming health care delivery in Ontario by enabling the secure electronic exchange of health information.

Currently, “there’s no place where medical records are comprehensively aggregated,” said CEO William Albino. “They’re spread all over the place. Our job is to bring them together over time.”

Much has already been accomplished. SSHA’s ONE Network, for example, provides secure, high-bandwidth connectivity to 7,000 sites across the province. ONE Mail provides secure email communication for the province’s health-care sector and, behind the scenes, work is progressing on the nuts and bolts underlying the system.

“Many of the applications are being developed in other parts of the Ontario health care system and brought to us to scale up,” said Albino. “For example, the Ontario Laboratory Information System (OLIS) was built largely inside the Ministry and it’s now moved to us for rollout and operation.

“A lot of Picture Archiving and Communication systems (PACS) were developed by PACS vendors and they will be brought to us to host over time, so our job is to make sure that all these things come together, integrate and interoperate.”

Several applications are already up and running. The electronic Child Health Network, eCHN, is an electronic medical record system that links physicians to test results and clinical notes for children who have been referred to out of town specialists (see story on Page 13), while the Drug Profile Viewer allows emergency room staff to access information on current medications for more than one million Ontarians covered by the Ontario Drug Benefits Program.

“Every time they fill a prescription, it gets processed through a system that records who they are and what they were prescribed, so if they end up in an emergency room, a list of their current medications is accessible,” said Albino.

“In Ontario, 15 per cent of seniors end up in emergency rooms every year. On average they’re taking four medications and, normally, they never know what they are. The number of people affected by avoidable drug interactions in Canada is surprisingly high, so with seniors using ERs with that regularity and inevitably on some medication, the ability to call them up and see exactly what they’re on prevents a lot of errors. Some day, we want to have the drug profile for every Ontarian available. That’s a couple years off, but there’s an active program to start to think that through.”

The Ontario Laboratory Information System will allow physicians to requisition tests and receive results electronically, saving time and money. Emergency room staff will also be able to access test results, once again speeding treatment decisions and avoiding duplication.

Currently, Ontarian have 200 million laboratory tests per year, costing the government $3 billion. SSHA estimates that 20 per cent of them are redundant and would not be necessary if health-care staff have access to recent tests online.

Physicians

Physicians in Ontario have been slow to adopt electronic medical record software, but that’s changing since the Ministry of Health and Long-Term Care mandated family health teams to acquire EMR systems and agreed to fund them.

Still, much of the information in physician offices is in bulging file folders, and many of the records that are digital are in standalone systems not currently accessible over the network.

SSHA would prefer physicians to opt for Application Service Provider (ASP) solutions hosted at its data centre in Toronto, but standalone systems with local data storage have had wider acceptance to date.

It will be more complicated to build links to data stored in standalone systems, but Albino is confident that the challenge will be overcome.

Hospitals are much further ahead, but operate in their own little worlds, said Albino.

Some of them, such as Sudbury Regional, have built co-operative linkages with other hospitals (see story on Page 14). The goal for SSHA, however, “is to develop an overarching framework to make sure the information can flow up to our system and back down to wherever it’s needed.”

Directory

Another challenge the SSHA is tackling is the development of an electronic master patient index, or directory, which is necessary to have absolute certainty about the identification of every Ontarian.

To illustrate the problem, Albino points out that there may be as many as 400 John Smiths in the province. Once health information from multiple sources is brought together, it will be necessary to ensure that a blood test for one John Smith isn’t mistakenly appended to someone else’s record.

“The patient directory is being built now by aggregating data from OHIP and other sources. The software we are using does the data analysis, takes the name, the date of birth, the current address, the previous address, the OHIP number and other unique identifiers to determine if it’s the same person.”

The task is further complicated by people of various ethnic origins who invert their names.

There is also a health-care provider directory of 20,000 physicians and 140,000 other health-care workers to ensure that reports don’t go to the wrong Dr. Smith.

Privacy

Given the public’s concerns about the privacy and security of electronic health information in central databases, SSHA performs threat and risk assessments on all of its applications, said Michael Power, vice president of privacy and security.

“Before we roll out any of these systems, they go through a rigourous set of assessments. We look at a system from end to end, how to get into it, how to break it and how the data could become lost or misdirected.”

Audit logs record every lookup in the system, every user is authenticated, and staff at SSHA’s network control centre monitor the network 24/7 using sophisticated intrusion detection tools.

“We also leverage our experience to help other players in the system address privacy and security issues,” said Power.

Electronic medical records are expected to produce a five to seven per cent improvement in productivity. Given Ontario’s current health care expenditures of $46 billion, “five per cent won’t hurt, but the biggest advantage of electronic health care,” said Albino, “is better health care.”

www.ssha.on.ca