Good governance is the missing prescription for better digital health care

digital health care

By Linying Dong

Recently Ontario released its Digital First for Health strategy — aiming to further digitize health care and end the problem of overcrowded hospitals and “hallway medicine.”

While applauding the government’s continuous effort to improve quality health care through digital health, one can’t help wonder about the bumpy journey this has been to date.

It has been a journey involving large financial investments — from the launch of Canada Health Infoway in 2001 to use technology for more efficient delivery of services, to the billion-dollar project eHealth Ontario in 2008 to create electronic health records.

However, despite being the most expensive universal-access health-care system in the Organization for Economic Co-operation and Development (OECD), the Canadian health-care system continues to grapple with chronic challenges. These include skyrocketing health-care costsunbearable wait times and an aging population.

It is puzzling that one of our most cherished Canadian institutions — our public health-care system — struggles to reap the benefits of the digital revolution, while other industries such as banking and retail have already harnessed advanced technologies to deliver fast and convenient services.

The reason: our health-care system lacks good governance.

Software systems must work together

For example, one key contributor to the hallway medicine issue is the lack of system interoperability.

In other words, multiple software systems are needed to support the transition of a patient from hospital care to community care. In Ontario, the Client Health and Related Information System (CHRIS) helps this process and is available province-wide.

Unfortunately, some EMR systems are not interoperable with CHRIS and as a result, care plans are faxed, duplicated and not always synchronized when updated. The result: a long waiting time to transition a patient, which results in hallway medicine.

health-care system
A piecemeal approach to digitization will not prepare our health-care system for the aging population. (Shutterstock)

There are other painful effects of our fragmented health-care systems: hospital readmissions and excessive wait times for medical diagnoses and treatments, to name just two.

What is more, the current piecemeal approach to digitization will not prepare our health-care system for the aging population. This will result in an increase in elderly patients who have multiple chronic conditions and require care from multiple service providers.

A change of mindset is needed

Granted, significant improvements have been made in different provinces. According to the Canadian Medical Association 2017 Physician Workforce Survey, more than 82 per cent of primary care doctors used an electronic medical record system across provinces and 85 per cent of primary care doctors accessed lab results and notes electronically.

Hospitals and health-care agencies have also allocated significant resources to modernize their IT systems and embrace IT into their daily operations.

However, the key issue here is to change the mindset that more technologies will cure our health-care system. While it always sounds exciting to introduce new technologies in hope that they will do wonders, more systems would not fundamentally address the painful issues Canadians have been experiencing.

Transparency and accountability

Instead, we need a governance structure in place — to fund only IT investment initiatives that are interoperable with existing backbone systems. Better data access should be achieved not through fax machines, phone calls, post mails, printouts and emails, but through seamless integration of technologies that allow data to be communicated without losing its accuracy, completeness and timeliness.

Good governance stresses transparent funding policies and accountability that links investments to outcomes. Private organizations rely on governance to reduce costs and make businesses agile and scalable. The number one component of the national e-health strategy recommended by the World Health Organization (WHO) is governance.

However, governance has not yet been paid much attention to by either government officials or health-care service providers. It explains the bumpy road we have experienced in our path of health-care digitalization.

As technologies are deeply ingrained in our health-care system, it is critical to have better governance — in order for Canadians to enjoy world-class digital health care.

The article was first published in The Conversation

About the Author

Linying Dong

Linying Dong is a Professor, Ted Rogers School of Information Technology Management, Ryerson University. She Graduated from Richard Ivey School of Business in 2004, Dr. Dong has actively engaged in research, teaching, and services, and become a valuable member of Ted Rogers School of Information Technology Management (TRSITM).

She has published in top tier IS journals including Journal of Information Technology (JIT), European Journal of Information Systems (EJIS), and Information Systems Journal (ISJ), and won Best Paper Award (AMCIS 2000), Meritorious Award (ISECON 2006), and highly recommended for Awards for Excellence (Emerald 2009) for her publications. Dr. Dong has also been awarded various internal and external research funds (e.g., SSRHC, OCE, Mitacs).

The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of The Political Anthropologist.