Is this the future of hospitals in Canada?
Canada lags behind other countries in moving health care into digital age
From the moment patients enter the new Humber River Hospital, slated to open in Toronto in 2015, they will have the power to change the room temperature, control the lighting, video chat with their nurse and read their medical charts on a bedside monitor.
"The control of their environment and the participation in their care" will be the biggest changes for a patient entering the fully digital, 656-bed hospital, said Barb Collins, Humber River's chief operating officer and lead of the redevelopment project.
Cutting down on "sneaker time" — the amount of time nurses and doctors spend walking to different parts of the hospital to deliver care — was a key priority when designing the hospital in northwest Toronto, which will replace three existing sites as Humber's main acute care centre, Collins said.
Instead of a call bell, patients, the bulk of whom will be in single-bed rooms, communicate directly with nurses through a video link. Nurses will also no longer record blood pressure, temperature and other vital signs on paper and have to transfer them to a patient's chart. All results will be automatically communicated from the device to the electronic medical chart.
"Now, I spend the time talking to you about what that blood pressure means, not running up the hallway to record that blood pressure," said Collins.
The way supplies move throughout the hospital will also be more efficient. Food, medicine, waste, linen and other items will be transported around the hospital through a system of chutes and automated guided vehicles.
Canadian hospitals slow to digitize
For all the high-tech equipment found in a modern Canadian hospital, there is still an astounding amount of paper: large, clumsy binders hold patients' medical charts, nurses record vital signs on scraps of paper and doctors issue orders in often illegible scrawl.
The Veterans Health Administration in the U.S. has been using electronic health records in its 152 hospitals and 800 community-based clinics since the 1990s. The VA system, which serves 8.3 million veterans, has also been proactive in adopting technologies like the web-based patient portal, in which patients can check their medical records, send secure messages to their health-care providers and order prescription refills.
It has had a broad telehealth program since the mid-2000s that allows home monitoring of patients with chronic health problems through devices that transmit health data directly to practitioners. In 2012, telehealth reduced VA hospital admissions by 38 per cent and length of hospital stays by 58 per cent.
VA hospitals are also about to launch a mobile-health pilot project that will enable severely injured veterans or their caregivers to review medical records, refill prescriptions and manage their health on an iPad.
Canada's efforts to digitize the health-care system have been underway for more than a decade, but progress has been slow.
The country lags far behind many other jurisdictions such as Denmark, New Zealand and Sweden, which have been using electronic health records for several years.
What's more, "e-health" has become synonymous with government boondoggles. The country has spent $4 billion on the endeavour, but e-health initiatives in Ontario, B.C., N.B. and P.E.I. have all been accused of mishandling the awarding of contracts and having little to show for the amount of money invested.
Canada Health Infoway, the federal Crown corporation overseeing and funding the transition to a digital health-care system, was praised in a 2009 auditor general's report for its effective management, but the auditor general also raised questions about some aspects of the way Infoway awards contracts. The agency has been criticized for not delivering on its goal of having electronic health records of at least 50 per cent of Canadians available to physicians by 2010 and accused of focusing too much on creating a large nationally standardized e-records infrastructure and not enough on having systems in place locally and regionally, where most health care is delivered.
A similar $4.2 billion national project to digitize health records in the U.K. was deemed to be too ambitious and wasteful and was eventually abandoned in favour of allowing hospitals to develop their own systems.
Alberta was the first province to institute a provincewide electronic health record system in 2005 — called Netcare — and several provinces have followed suit since then.
Individual hospitals, such as Sunnybrook Health Sciences Centre in Toronto, which lets patients access their medical charts online, use electronic health records to a degree.
But a 2011 review of Canada's e-health plan in the Canadian Medical Association Journal found that the systems often lack key components that are needed in order for clinicians to actually use the records in the delivery of care. These include things like digital problem lists that identify a patient's most serious diagnoses and automated tools to assist physicians in decision-making.
Health-care technology just a tool
Electronic medical records and other digital technologies have the potential to improve patient outcomes by helping hospitals identify and track infections, medication errors and other adverse events and alerting physicians to drug interactions and other problems.
One way of assessing how "digital" a hospital is is through a scale developed by the Healthcare Information and Management Systems Society (HIMSS). It ranks hospitals' progress in adopting an integrated electronic records system that includes patient records, laboratory and medical imaging systems, and technologies that help doctors and nurses manage and deliver care.
Only four Canadian hospitals have achieved Stage 6 on the HIMSS scale as of the end of 2012. None were at Stage 7, the highest category, while 104 were in the U.S; and only about three per cent were at Stage 4 or higher, compared to 38 per cent in the U.S.
The four Stage 6 hospitals in Canada are: St. Michael's Hospital and North York General Hospital in Toronto; Ontario Shores Centre for Mental Health Sciences in Whitby, Ont.; and the South Okanagan General Hospital in Oliver, B.C.
However, many hospitals don't use them in this way, says Ashish Jha, professor in the health policy and management department at Harvard University's School of Public Health.
"Most hospitals have implemented technology not to address these issues but to try to either create efficiencies or get better at billing, get better at coding," he said.
Technology is just a tool, Jha says, and if it's applied to the most pressing clinical problems that patients care about, it can have a big impact.
"The unfortunate part is, to date, we haven't seen a lot of evidence that people are applying technology to these problems," he said.
At Humber River, Collins says, the intention of all the interlinking high-tech systems is to make the hospital safer and more efficient.
Medication errors are expected to be reduced thanks to wristbands with a barcode that will be scanned to confirm the patient is receiving the right medication and will record who administered it and when in the patient's chart.
"The care should be faster, it should be more accurate, and it should allow a better link between that medical record and the practitioners caring for that patient," Collins said.
Oslo hospital a model
Humber River modeled a lot of its operations on Akershus University Hospital in Oslo, which has been operating as a fully digital hospital since 2008.
"What you first of all will experience when you visit our hospital is that it is quite quiet in all the areas, because you don't see blinking lights, you don't hear audible signals from the patient call systems," said Kjell Borthne, director of the hospital's diagnostics and technology division.
All doctors, nurses and patients at Akershus, known as Ahus, are outfitted with IP telephones that can transmit voice and data, and patients, who are mostly housed in single-bed rooms, have bedside monitors that allow them to view their medical charts and connect to the internet.
Electronic whiteboards at nursing stations and in emergency rooms provide continuous updates on patients.
"[They give] an efficient overview for the clinical personnel of where the patients are, what are the status of tests — have they been taken? Are they analyzed? Is the radiology finished?" said Borthne. "That is very efficient for the flow of work in the departments."
The Oslo hospital's move to the digital age has also had another bonus: more efficient clinical operations enabled them to reduce the number of days patients spend in the hospital from about 5 to 3.5, Borthne said. (Although technology wasn't much help in 2011, when an increase in patient volume and staffing shortages led to several fatal lapses in patient care.)
The technological transition hasn't been problem-free, however.
On three separate occasions, Ahus's entire system went down for several hours, knocking out all IP phone communication, automated supply vehicles and, most importantly, patient medical records.
The hospital had to divert ambulances, call in extra staff, switch to GSM cellphones and print out paper patient records from a backup system.
"One of the lessons we have learned is that a digital system is always error prone, so you can't be sure of having 100 per cent up time for any digital system," Borthne said.