Infoway to become more responsive to needs, CEO vows

Canada Health Infoway must rapidly reboot, and do so in substantial fashion, if it’s to justify public outlays beyond the billions already spent on developing a national electronic health infrastructure, according to the crown corporation’s CEO.

After years of defending a strategy favouring massive centralized data systems over meaningful use of electronic health data by physicians and patients, Richard Alvarez, Infoway’s top mandarin, told an audience in Vancouver, British Columbia, on May 29 that the agency must reprioritize its activities — Canada’s existing approach has left it lagging dismally behind international counterparts such as Australia and New Zealand in achieving health improvements through electronic technologies.

Canada Health Infoway has long been assailed for its e-health strategy and a long list of critics has long contended that its approach needed to be refocused. CEO Richard Alvarez says that reset is coming.

Image courtesy of © 2012 Thinkstock

The deficiency is particularly acute with regard to physician use of electronic medical records, Alvarez said. “We’ve got to get the numbers up.”

Infoway’s top priority in the future must be to develop “consumer health systems” that permit “patient monitoring at home,” Alvarez told delegates to e-Health 2012: Innovating Health e-Care. There is “evidence from around the world” that consumers are demanding such systems, he added.

Alvarez laid out the proposed change as a necessary condition to receiving new funding from the federal government. The agency, created in 2001, has already received roughly $2.1 billion, though funding is scheduled to expire in 2015.

Should it receive more money, Alvarez said, the agency will pursue the development of systems to provide an “enhanced patient experience” centred on e-scheduling of appointments, e-prescribing and e-visits (i.e., electronic patient–client encounters).

“I can do this in every other part of my life, why not health care?” he asked.

Infoway would also “support new models of care” that promote patient safety through such means as greater use of e-referrals and the provision of e-summaries of patient information upon discharge from hospitals.

In presenting a vision of a health care system reformed by mobile devices and patient Internet accounts, Alvarez also indicated he has no concerns that some patients may be unable to afford such technologies and thus compromise the notion of universal accessibility.

While rounding out his list of priorities, Alvarez borrowed former United States President George W. Bush’s call for a “coalition of the willing” to enable electronic data capture and analysis across the health system and open “the next frontier of decision support and knowledge.”

Alvarez’s assertions essentially reaffirm an earlier Infoway admission of a need to slowly tack toward applications that promote daily use of electronic records (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3798).

It was only in 2009, after spending more than $1 billion on a still-incomplete and little-used patchwork of megasystems, that Infoway allocated any monies to helping clinicians implement systems. As for the need to connect patients, Alvarez admitted “it is the will of the people to move in this direction” and screened a video of a ship captain ordering a lighthouse to clear his path, but Infoway has yet to commit more than a sliver of its budget in such a direction.

Infoway has long been assailed for its e-health strategy and many critics have contended that its approach needs refocussing (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3744). The litany of woes include an external performance audit commissioned by the agency that indicated it missed its program targets by a wide margin (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3860) and assertions from the Auditor-General of Canada that implementation of the national e-health strategy has been “haphazard” (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3242). Progress has been so dismal and outlays so wasted that some observers have urged that an independent national “watchdog” be appointed to assess and oversee federal e-health efforts (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3783).

But Alvarez told the Vancouver audience the failures have been a function of complexity. “We’re not there yet because it’s hard,” he said. “We can take solace in that.”

Alvarez also said physicians have lacked “motivation” in adopting electronic medical records, and that there “doesn’t seem to be a push from patient safety advocates.”

There has been progress, though, in telehealth, drug information systems and diagnostic imaging, Alvarez said, asserting that Infoway investments have generated more than $6.2 billion in benefits since 2007.

Alvarez said Infoway consulted 500 people in crafting its plan to convince the federal government to extend funding. Infoway has long estimated that implementing its blueprint, issued in 2006, will cost at least $10 billion — or an additional $8 billion. A revised blueprint, once promised for 2010, remains incomplete, Alvarez told CMAJ. “When it is ready, we will send it to you.”