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© Copyright 2000 Rogers Media. The following article first appeared in the January 2000 edition of
BENEFITS CANADA magazine.
The future of healthcare
A central database of personal health information is on the horizon.
Are you ready to help employees come onside?
BY ANDREA DAVIS
It's the middle of winter and Jennifer is going to visit her parents for the weekend. Jennifer's hometown,
where her parents still live, is a few hours drive from the city where she lives and works. It's Friday
night, it's snowing and the roads are slippery. Jennifer sees the brake lights on the car in front of her
and slowly applies pressure to her brakes. Her car's wheels spin out on the icy road and the vehicle slides
into oncoming traffic. Jennifer is hit by an oncoming car.
Later, in the nearest hospital an hour away from her parents, Jennifer is unconscious, unable to give
emergency room staff her medical history. She needs surgery to save her life. But doctors aren't aware of
her allergy to a certain type of anaesthetic because Jennifer's Medic Alert bracelet was lost in the
accident. Nor are doctors aware that she has epilepsy and takes medication to control her seizures.
If Jennifer was your employee, daughter, sister or friend, wouldn't you want those emergency room doctors
to have access to any information that might be critical to her care?
THE DATABASE
The above scenario, while ficticious, illustrates what many see as a growing problem in today's healthcare
system: the lack of an integrated database where healthcare practitioners and institutions--physicians,
hospitals, nurses, pharmacists and others--could go to access a patient's entire medical history.
This database would be the nerve centre of a new integrated healthcare system. To start, physicians,
hospitals and pharmacists would have access, inputting patient data. Eventually, dental offices,
chiropractors, nurses, nursing homes, homecare workers, physiotherapists and any other healthcare
practitioner would be linked up.
Each provincial government would maintain a database. Ideally, the system would have inter-provincial links
to reflect the fact that Canadians travel and move around the country. For example, if your plan member who
lives in Ontario is on vacation in the Rockies and has a skiing accident, physicians in British Columbia
would have instantaneous access to the patient's medical history.
The database would require cooperation from a multitude of stakeholders, including provincial governments
and the medical community. Such a database would increase the efficiency of the healthcare system--and
ultimately lower costs for all stakeholders, including employers--because physicians would know what drugs
the patient was taking and how many other medical practitioners the patient was seeing.
"You cannot have proper treatment if you don't have proper information," says Jim Norton, senior
vice-president at Aon Consulting in Toronto. "That's the bottom line."
AN EMPLOYER'S VIEW
One of the biggest challenges plan sponsors face is measuring outcomes of benefits programs--wellness
initiatives and disability management programs, for example. Using an integrated approach and some kind of
electronic link with providers, plan sponsors would be able to evaluate the benefits of such programs.
Take, for instance, drug utilization reviews. If your group insurance carrier had the ability to use
information from its drug database to determine if one of your plan members was at high risk for a certain
disability then, with an integrated system, the insurer could share that information with the plan member
and take appropriate measures to either prevent the disability from occurring or minimize the disability
when it does occur. In an ideal world, that information could then be linked to the public database.
From an employer's perspective, Cyril Theriault doesn't have any major concerns with a centralized
database. Theriault is director of the public service employee benefits branch in the Department of Finance
in the province of New Brunswick.
"As an employer, I don't see anything wrong with it," he says. "And as a benefits administrator, I think it
would be great, with the provision that you're going to have to have some pretty strict confidentiality and
privacy guidelines." Theriault does foresee resistance from unions and employees, however.
"For instance, if an employee went to the doctor and got a note to be off work for a few days, the unions
wouldn't even like us asking why the employee's off work. They figure the reason is their own and, as an
employer, we don't need to know," he says. "But if it's an absence that may lead to a longer term absence
and insured programs may kick in, from a benefits administrator's point of view, sometimes it's nice to
know so that early intervention can start."
PRIVACY CONCERNS
Naturally, integration raises confidentiality concerns (see "The state of privacy legislation,"). Plan
members might be upset if their confidential health information was at risk of being disclosed to their
employers. But advocates of integration see no need for employees to be concerned.
"Employers would not have access to this [public sector] database," says Fred Holmes, senior consultant at
Buck Consultants in Toronto. "The database is for the health of the individual. Any party unrelated to that
focus should not have access."
Plan sponsors agree. They should not expect to have access.
"As a disability management program, we're not directing the treatment of the employee," says Sharon
Blaney, director of corporate health at Telus in Burnaby, B.C. "We're looking at the return-to-work
aspects, what is the employee able to do and do we have a job that they could come back to do."
Nonetheless, employers have a stake in seeing such a database built. It's in the best interests of
employers that their employees receive prompt, accurate diagnoses and treatment for illnesses so they can
return to work.
In fact, a secure electronic network might even be safer than the current system, where individual medical
practitioners keep separate paper files. "There's very lax security now," says Norton. "You can have
medical data in 20 different places. It's kept in cabinets, in several different places. And it's not
protected at all."
TIMING ISSUES
A central database is an enormous undertaking and the idea is still in its infancy. But with the first wave
of baby boomers now entering their 50s, it's likely they will be the driving force behind such a database.
"There will be a lot of work to create the database but the baby boomers will ultimately demand it for
selfish reasons," says Holmes. "Every baby boomer who is currently in the sandwich generation will be
appalled at the lack of accumulated data that exists with respect to their own parents whose care these
baby boomer children must now stand up and be an advocate for."
For providers to the private sector, linking up with the public system is a long way off. The public
database would have to be up and running before private sector providers could hook up to it.
"Although we know that ultimately we need integration with the public sector on our radar screen, to
actually initiate the interface at this time would be premature," says Barry Noble, national director of
managed care at Manulife Financial in Toronto.
IT'S A WIRED WORLD
One of the major roadblocks to an integrated healthcare system is that few family physicians in Canada use
computers for clinical work.
It's one thing for physicians to do administrative work using computers but up until now, many haven't had
the chance to experience the potential benefits of doing clinical work with computers. "It's still in the
experimental stages," says Dr. Robert Perreault, a senior researcher at Direction de la santé publique
de Montreal-Centre in Montreal (see "The Quebec experience," page 23).
The day medical practice becomes computerized, physicians will be in a position to be much more efficient
in how they interact with patients, with the healthcare system and ultimately with the employer community.
"It's ludicrous for doctors to still be in the paper world when the rest of us are in the electronic
world," says Holmes.
Another major challenge such a system presents is communicating that a centralized database is in the best
interest of patients. It would also be critical to communicate to plan members that their employers would
not have access. "It would help allay any fears they might have," says Theriault.
THE ROAD AHEAD
Advocates of an integrated healthcare system argue a central database would help eliminate preventable
deaths and unnecessary hospitalizations. Critics believe privacy and confidentiality are paramount. It's a
debate that's not likely to subside any time soon. Plan sponsors, meanwhile, are acutely aware that they
walk a fine line with employees.
In this age of electronic data and high-speed communications, plan sponsors need to be aware of concerns
plan members may have about their potentially sensitive health data. A centralized database of health
information might still be a decade away, but employers should be prepared to address concerns now.
Andrea Davis is assistant editor of BENEFITS CANADA.
*** ***
The state of privacy legislation
The federal government is currently trying to pass legislation protecting Canadians' personal information
from unlawful use. Bill C-6, the Personal Information Protection and Electronic Documents Act, will apply
to all commercial activity. The legislation has been passed by the House of Commons. The Senate, however,
backed a recommendation from its social affairs committee to postpone sections of the legislation dealing
with health privacy for a full year once the rest of the bill takes effect. At press time, the Senate still
had to give the amended bill final approval and send it back to the House of Commons with the changes.
Bill C-6 would require that an individual's consent be given before personal information is shared with a
third party. It's supported by proponents of e-commerce, who hope it will ease consumers' concerns about
Internet transactions. Public institutions, such as hospitals, are exempt from the legislation, but it
would require other healthcare organizations such as pharmacies, laboratories and homecare practitioners to
obtain patient consent before sharing information.
The proposal faced opposition from Ontario's Ministry of Health and the Canadian Pharmacists Association
who say it will impede the exchange of health information for research purposes. But other organizations,
such as the Canadian Medical Association and the College of Family Physicians of Canada, say the
legislation doesn't go far enough.
"It's an issue that individuals are going to be hearing about a lot more often," says Charlie Black, senior
advisor, insurance operations at the Canadian Life and Health Insurance Association. "Benefits plan members
are going to be more aware of what might be done with their information. If they're not assured their
information is going to be protected, they may lose trust in the benefits plan."
*** ***
The Quebec experience
The province of Quebec is the most far along in the quest for an integrated healthcare system. In 1997, Dr.
Robert Perreault, a senior researcher at Direction de la santé publique de Montreal-Centre, and a team
of researchers launched the MOXXI project--short for Medical Office of the 21st Century.
MOXXI was a pilot project that gave doctors electronic access to the drug database of the régie
d'assurance médicale du Quebec (RAMQ). Fifty-five physicians in the province were able to access the
medication lists of their elderly patients. Another 55 physicians acted as the control group. Patients,
meanwhile, signed a release form allowing their drug data to be released to their physician and the
research team.
At the end of the study in 1998, Perreault and his team concluded that by providing access to this
information, physicians were able to reduce prescription errors--mistakes that were potentially
dangerous--by 25% to 30%.
Buoyed by the results, Perreault is taking MOXXI to the next level. Using a smaller sample of 20
physicians, researchers have expanded the project to give doctors access to lab results, hospital discharge
summaries and practice guidelines. The results of phase two will be published in 2001.
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