BRAMPTON, Ont. - When the first patients walk through the doors of the new Brampton Civic Hospital in a couple of weeks, they will be entering a centre like no other in Canada -- but one that will increasingly become the standard for health-care delivery across the country.
From check-in and lab tests to bedside care and drug dispensing, the $550-million institution that makes up one part of the three-hospital William Osler Health Centre northwest of Toronto is a model of electronic health -- or e-health, as it's been dubbed.
Checking in or coming for a test? Electronic kiosks will allow patients to register with a swipe of their health cards, get a map directing them to the correct department and provide the service in eight languages, from English and French to Italian and Hindi. At a nearby "fast-lane'' desk, a clerk will check photo identification and issue a hospital bracelet that next year will include a scannable bar code.
Going the way of the dust bin are paper records: all patient information will be logged onto computer, including blood test results and digitized X-rays and other images, which can be called up by authorized clerks, nurses and physicians anywhere in the hospital with the click of a mouse.
The hospital is completely wireless. Computerized monitors at the bedside record a patient's vital signs and allow treatment information to be added by nurses on the spot. And those real-time recordings will be accessible through hand-held devices carried by health providers that permit them to monitor changes, respond to emergency codes or just answer a patient's call for assistance.
"Innovative technology supports our health centre's objectives to increase efficiency, realize savings and focus on patient care,'' says Judy Middleton, chief information officer for the 479-bed hospital. "It is transforming the future of health-care provision and management.''
Even drug dispensing will be computer-controlled. In the basement of the sprawling complex, a monster "drug robot'' called PillPick electronically packages prescriptions in sealed baggies, which are then delivered to nursing stations and mobile medication cabinets, called MedCOWS. Each bag is specially ordered for an individual patient for a 24-hour period.
Carol Dueck, a nurse and consultant on the project, says PillPick does not dispense controlled substances such as narcotics, which are kept and packaged elsewhere in the building under strict security measures to ensure they don't go astray.
What PillPick does offer "is 99.9 per cent accuracy in delivery'' of prescriptions, says Dueck, noting that the system was chosen because of its high patient safety profile. "It will ensure the right patient is getting the right pill at the right time.''
Richard Alvarez, president and CEO of Canada Health Infoway Inc., says Brampton Civic represents the latest addition in a movement towards making e-health a reality across the Canadian medical system.
It's an evolution in Canadian health care that is long overdue, says Alvarez, whose federally funded, non-profit organization is working with provinces and territories to invest in electronic health projects.
"The one big issue is that while technology has really touched all our lives and very many aspects of our lives for the better . . . it's been absolutely absent in health care and it is really time to play catch-up.''
Alvarez says Canadians can go to automated teller machines almost anywhere in the world -- including "a little village in India'' -- and access their bank accounts. By contrast, Canadian health-care delivery is stuck in the medical Dark Ages.
"We come back to Canada and in the middle of the night we have to go an emergency (department) or we have to take one of our parents or our kids to emergency,'' he says. "The attending physician will have absolutely no idea what medications your parents are on or even what your kids are on, because a lot of that medication history would be on paper sitting in somebody's file somewhere, scattered among how many clinicians they would have seen.''
That lack of accessible information can lead to mistakes, some with dire consequences, he says, noting that between 9,000 and 24,000 Canadians die each year because of adverse health-care events, many of them caused by deadly drug interactions.
"So if you can get the right information, the medication history for the right patient to the authorized person, just think of the lives it could save.''
As well, Alvarez says, there is a huge amount of time and resources spent on repeating diagnostic tests because the original results get lost in the paper shuffle that continues to be the status quo in most health systems across Canada.
"Anywhere from 10 to 15 per cent of lab tests, X-rays, diagnostic tests are unnecessary because they are duplicates,'' he says. "Well, by getting rid of paper and digitizing them so you can put them on a computer and then make them readily available, it's a lot more efficient for the patient.''
"And the quality of these (X-ray and other) images are so high-resolution, it improves the quality of care.''
Alvarez says that digitizing X-rays, for instance, would improve the productivity of radiologists -- which like many specialists are in short supply in Canada -- by up to 25 per cent, meaning they "do a lot more tests and see a lot more patients.''
Studies conducted for Canada Health Infoway estimate the cost of implementing e-health systems across the country over the next decade would range from $10 billion to $12 billion, or about $300 to $350 per capita.
"That's expensive,'' he concedes. "The benefits, on the other hand, are anywhere from $6 billion to $7 billion annually in savings.''
But the goal of a thoroughly digitized health-care system for all of Canada isn't without controversy.
Much of the concern centres on issues of privacy. Who would have access to a person's health records? How would this information be secured from unauthorized access? And how would a person's most intimate details be stored?
Aviv Shachak, a specialist in information studies at the University of Toronto, is a big supporter of e-health measures, but he agrees there are legitimate concerns about the handling of such delicate information that need to be ironed out.
"There is a huge issue about privacy and confidentiality,'' says Shachak, who recently joined the Toronto university after earning his PhD at the Galil Center for Medical Informatics, Telemedicine and Personalized Medicine in Israel.
"For example, if I'm depressed and I talked to my primary physician and then I broke my leg and I am sent to see an orthopedic surgeon, should the orthopedic surgeon know that I'm depressed or not?''
"On the one hand, that's between me and my family physician: why would he want to know that? On the other hand, if I'm taking a medication for my depression, for example, then he might need to know about it.''
"I don't have an answer to this.''
Concerns have been voiced about having everyone's health information stored on computer -- and what would happen if the system failed for various reasons. There are also fears that unauthorized persons could hack into the system and steal or change personal records.
Obviously, says Shachak, sophisticated back-up systems to protect data loss and security measures to thwart unwanted access would need to be in place.
"There are also sometimes unintended and undesirable consequences and we have to be very careful about it and pay attention so we can design better systems and better implementation processes.''
Alvarez says privacy and security constraints are being built into the system "basically at the highest level, because that's absolutely important.''
But he points to drug dispensing as an example of how electronics will trump a doctor's prescription pad almost every time when it comes to patient safety.
"We all know how famous or infamous doctors' handwriting is. There are a lot of errors caused because pharmacists cannot read either the drug or, worse still, the dosage. And those cause serious errors.''
"The system that we're talking about here, if you prescribe a drug that has too high a dosage or a drug that basically doesn't make a lot of sense, the system will pick it up and will spit it back at the doc and give them alerts in terms of what they've just done.''
"So there are a lot more safeguards in the (electronic) system than there ever will be with any paper system.''
