Starting in 1989 in Quebec, health care regionalization has marched its way province by province across Canada, with Ontario coming up last. Today, there are about 103 regional health authorities or equivalents, according to a 2006 survey by Branham Group.
Under the auspices of Canada Health Infoway, the provinces are driving the federal e-health agenda to digitize the components needed ultimately for electronic health records (EHRs).
"If this is a race, then everyone's still in the running," says Michael Martineau, Branham's e-health practice leader. "I would put Alberta and Newfoundland first, and probably a mix of Ontario and Manitoba last. But there aren't great disparities between first and last."
Although all provinces are pointed in a common direction, each has put different priorities around Infoway's agenda, he adds.
Alberta is the first province to have a complete provincial e-health record accessible by any physician in the province. It also has a fully electronic drug information system that allows physicians and pharmacies to share and access a patient's prescription history, and Saskatchewan's equivalent system is also advancing rapidly.
Atlantic Canada, by contrast, has focused on diagnostic imaging. Nova Scotia and PEI are completely digital, allowing all physicians in these provinces to view and move X-rays and other scans at any location. In Newfoundland, the core integration work in hospitals is complete and the province is starting to put in some of the advanced networking needed to share electronic records.
Martineau says Quebec has underinvested in IT in the past, but this has changed significantly in the past few years. The province recently launched many programs around electronic records and is set to leapfrog from its previous position.
Similarly, Manitoba is stepping up investments in this area and is taking a methodical approach in its planning and execution. B.C. has spent two years planning a 10-year strategy and is also marching along, he says.
In most provinces, increases in health care spending exceed the rate of economic growth year over year, which is unsustainable in the future, notes Martineau.
Chronic disease management is a common priority, as about 75 per cent of hospital admissions deal with complications from incurable diseases such as diabetes, asthma and so on.
Preventing the symptoms from worsening by managing and controlling them in community care settings is far less expensive than treating them in a hospital once conditions deteriorate.
Canada ranked last in conducting four simple tests consistently to detect and manage diabetes, according to a 2005 survey conducted by the New York-based Commonwealth Fund that compared six industrial nations.
"Treating a disease earlier is an IT problem," says Martineau, as this means organizing, tracking and analyzing these types of tests regularly in a large population over time, a feat that is virtually impossible without an integrated system.
There is a strong correlation between regionalization and IT integration, he adds, and more advanced provinces such as Alberta and Newfoundland have a high degree of both. "It's very clear that regionalization drives enterprise-level thinking."
There are two types of regional health care models, he says. In Ontario and Quebec, the two most populous provinces, regional entities are essentially planning and coordinating bodies that flow funding allocated by their health ministries.
However, Quebec takes a centralized approach to IT projects and capital spending and tracks these separately, unlike Ontario. In the rest of Canada, most regional health authorities own health care facilities and are responsible for delivering care, although there are many hybrid models.
"There are some regions where people say they have full operational responsibilities, but they're actually hybrids in some cases," says Martineau.
In B.C., for example, several hospitals have their own boards of directors as an executive layer between the regional health authority. This is an area of major controversy in Ontario, says Martineau: whether hospital boards should remain in place under LHINs, or be eliminated entirely.
"Many point to Alberta and say it got rid of its boards and seems successful," he says. But all provinces have unique features, he adds, and what works for a population of 3.5 million may not work for 12 million.
Unlike most provinces, Ontario has a large percentage of medium-sized hospitals and a huge, densely populated swatch from Windsor through to North Bay, and there is a similar scenario in the Montreal-Quebec City corridor. "It may be a function of size, but until you go through with it, it's just an academic argument."
A universal issue is inadequate IT budgets in the health care sector, which are about 2.2 per cent of operating budgets, compared with about five per cent in other sectors, Martineau notes.
Another issue that looms over all sectors is the shortage of trained IT staff, and this is particularly acute in health care where people need specialized knowledge about the clinical side.
"Some CIOs have said, even if you gave me twice as much money, I probably couldn't spend it as I'm running out of staff resources," says Martineau.
"Here's where we hit the classic Canadian situation: since education is a provincial responsibility, like health care, it's very difficult to solve the IT training problem on a pan-Canadian basis."
Rosie Lombardi is a freelance writer based in Toronto. She can be reached at rosie@rosie-lombardi.com
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