This morning the Vancouver Sun (@VancouverNews_) posted "Telus's secure online service will let patients see their medical files" Nice idea but they are absolutely not capable of achieving anything like they talk about in the article any time soon. I discuss why....
It is a noble cause that Telus's CEO Darren Entwistle has taken on to improve access to patient data having lost his father in part due to data access issues. Unfortunately, the Vancouver Sun article and the Telus Press release that it is likely based upon, makes it sound like all we need is Telus to start using Microsoft's HealthVault and magically patients will access all their health records. At least when Apple promises some magic, they deliver something and make us think it is special. There is no way that Telus can deliver their magical solution as simply hosting a medium to access health records does not mean any data will be in theHealthVault.
To date, Telus has failed in providing high speed internet access to physicians in this province. The technology of course exists but it is too costly and they cannot just give their services away. So, building their pipe has to come first and can be achieved with time and lots of money. What cannot be accomplished anytime soon: getting the patient data entered. Infrastructure is needed and perhaps Telus is dedicated to making this happen but they need to be involved and somebody has to cover the massive costs in each piece of the puzzle. At least as a publicly traded telecommunications company Telus have a much better chance of making this happen than the government on their own with highly paid consultants.
The high speed data pipe isn’t working
In BC, there are a handful of Physician Information Technology Office (PITO) approved EMR systems that had to comply to certain standards in order for physicians to receive some incentive funding. One of these criteria to date has been the requirement that a dedicated internet line provided by Telus is used and that ALL patient data is stored off site with their system. I am fortunate to have never agreed to this as this system is not working out well for many of my colleagues. The dedicated Telus system is so slow that it is unusable. A medical office cannot wait 45 seconds for a keystroke to be transmitted in order to book a patient’s appointment or enter data; this process has to be near instantaneous. So, Telus, a telecommunications company, is failing at what they should know how to do…transmit data at high speeds.
We need fibre optic lines to all physician offices in all regions as a minimum requirement for this concept of health data access to even get started. Near instantaneous response to each keystroke to data being stored off-site is mandatory or there is no way physicians can use this system.
Entering the healthcare data; the missing link
Assuming one day we have fibre optic data access to every health care provider in this province, how will the data get entered into the HealthVault? Yes, standard answers would be that either every physician uses the same EMR system or that their EMR system seamlessly exports the necessary data. There are enough differences in the data that is collected and in practice styles, that there is no one single EMR that can every work for every healthcare provider. As for exporting the data, if a pdf type copy of the exam form is sufficient, then probably any EMR can export their data but this is a terrible way of retrieving data when needed. This is the part of the access to healthcare information that I don’t see happening in my lifetime.
To summarize, the steps that can be achieved but are still many years away have to do with just laying down high speed data connections to all healthcare providers. The technology exists but is costly for retrofitting any existing buildings. Having a medium for data storage such as the health vault will be a good next step once we have high speed access to save and retrieve the data to it. Getting the data from healthcare providers into the HealthVault is the biggest challenge is it takes more than just money; it will take so much cooperation between doctors, EMR vendors, the government, telecommunications companies and privacy advocates that it will be near impossible to achieve.