eHealth Ontario CEO addresses Economic Club of Canada

Thank you very much, Lisa.
Thank you to the Economic Club for inviting me today,
and thank you all for coming.
Lisa, your opening comments--
I actually hadn't thought of a parallel before,
but we're in the business of trying to track
13 million packages called "Ontarians,"
and we know the internal temperature should be 98.6.
(Laughing)
It has been almost two years that I've been in this job.
It's relatively easy for me to remember how long I've been here
because I began on April Fool's day 2010,
so coming up on the second anniversary.
And this is a good time to talk about the progress we're making
in electronic healthcare.
Although, when we booked this date,
I didn't realise how timely it might be.
I did not know that our Health Minister would be announcing
a transformative plan for healthcare in the province
at the Economic Club two weeks ago.
I did not know that our Finance Minster would be talking about
the transformation of the Ontario economy
at the Economic Club yesterday,
and I did not know that Mr. Drummond
would be releasing his report tomorrow.
So this is timely.
And I feel a little bit like a public service
who's out wandering in traffic right now,
so I hope not to say anything too controversial.
Let me start with eHealth Ontario's mission.
It's actually deceptively simple, and it's this:
any time any one of you goes to a healthcare provider,
it could be your family physician,
it could be a nurse in a clinic,
you could be unconscious in the emergency room.
We would like whoever's providing your healthcare
to have a complete picture of you
with all the information they need about you
in order to provide the best care possible.
This is not a new idea.
Any of you who have done online banking
or have dealt with an airline lately
know that they figured this out years ago.
Now, it took the banks about ten years
and probably three to four percent of revenue to do it,
but they found a way of consolidating
all of their smokestack businesses into a single view
of you and your relationship with the bank.
So you can now go online and you can see your checking account,
you can see your GICs, your credit cards,
all of your business with the bank.
Similarly, with an airline,
it doesn't matter whether you're at home booking a reservation,
whether or not you're checking into the kiosk at Pearson,
or whether or not your luggage is transferring to Frankfurt--
Well, actually, the luggage transferring through Frankfurt
is still a bit of a problem.
But they're able to present you with the information you need
to have a transaction with the airline.
I really don't want to think of healthcare as a transaction,
but that's really what's happening.
In business, it's called multi-channel management.
And that's really what we're engaged in.
We're engaged in packaging up the information
about your healthcare so that any time you're with a provider,
that healthcare transaction can occur.
It's not black art, it's been done before,
it's been done in many other industries,
and it's been in healthcare in other jurisdictions.
And one of the things we're trying to do
is not reinvent any wheels here,
we're trying to learn from the lessons of others
and take advantage of experience.
So let me turn to where we are in Ontario right now.
I'd like to talk about what we're doing,
I'd like to talk about how we're doing it,
and it'd like to talk about why it's important.
Now, in baseball, it's possible to look at something
called a box score.
I think there's nine boxes.
But if you know how to read the box and the numbers properly,
you can tell what happened in the baseball game.
What I'd like to do is very quickly go through
the box scores on eHealth Ontario today.
So, in Ontario today,
almost two-thirds of our primary care providers
out in the community, and almost one-third of our specialists
are working with electronic health records.
That means that something like 7.5 million Ontarians
have an electronic health record,
of the 13 million of us.
Now, those records, for the most part,
are a digitization of what used to be
in the hanging paper file in the doctor's office.
So I know my doctor can treat me better
because he can find the information more easily,
and he can find trends and he can compare year to year.
But the real promise of those records
is when we start providing clinicians with more information
than they would've had otherwise.
And during the course of this talk,
I'm going to talk about how we're bringing lab results,
diagnostic images, hospital reports
and other sources of information
that our clinicians would not have,
and making them available through those terminals.
Right now in Ontario, there are more doctors working with
electronic health records than there are
in all the other provinces of Canada combined.
We're not done. We have a long way to go.
But we have come a long ways in this province.
The Ontario Lab Information System,
which contains most of the lab results on most of us,
is now fully electronic and ready to be deployed
around the province.
It's been in trial at the Ottawa Hospital
for the past several months,
and we're about to begin rolling it out to hospitals, clinicians
and clinical groups around the province.
And that will be a big impact on all of us,
because instead of waiting weeks for the result of a lab test
that could determine whether or not
one has an important disease, the wait will be more like days.
So this will be a major improvement in quality of life
and it will enable people
to get on the care pathways they need to much sooner.
All of the diagnostic images
in our hospitals in Ontario are now digital.
That's CT Scans, MRIs, ultrasounds, x-rays.
There is no more film.
And they can be shipped from any hospital
to any other hospital in a matter of seconds.
There are a few hospitals I think in the Mississauga area
that we're still bringing online, but by and large,
that is fully electronic.
So, what that means is that patients are now getting care
from specialists far removed from where they are.
I spent time with a pathologist from UHN not long ago
who was looking at the pictures, the tissue samples,
of people in Northern Ontario,
and said they would never be able to receive
this level of specialization
unless we had that technology in place.
We have a special system
for some of the most serious injuries of head trauma.
And if somebody-- There's 100 trauma centres in the province.
If someone comes in with a head injury
caused by sports or an automobile accident,
the ER staff will do a CT Scan right away.
It's a three-dimensional picture of the brain.
We have a neurosurgeon on-call
24 by seven, 365 days a year.
There are 70 neurosurgeons, they take turns.
But right now, somewhere in the province,
there is a neurosurgeon who can look at that CT Scan
within minutes and advise the team in an ER
anywhere in the province on what to do.
And the practice prior to this was they got put in an ambulance
or an air ambulance, and sent to the nearest place
where there was a neurosurgeon.
And what's happening now is a lot of those patients
are being stabilized and being kept in their community.
And their either being not moved
or they're being moved later when it's safer.
Drugs.
I'm sure you've all seen the TV commercial now
where somebody's being rushed into emergency,
and the doctor says something like "Drugs are on-screen."
And then they rewind the tape and they say,
"Wouldn't it be great if your medical information
was available when you got rolled into emergency?"
In Ontario today, if you're a senior,
your drugs are on-screen.
There's a Drug Viewer in every ER in the province.
And what we've done
is we've taken the Ontario Drug Benefit Program,
which pays for drugs for seniors,
we found a way to turn that into a viewer so ER staff
have a pretty good idea what medications you're on for--
And it's something like
almost half the drugs in the province are on that.
So, a long way to go, but major progress.
Uh, community health centres are the front-line providers
of healthcare to some of the neediest Ontarians.
There are 110 of them around the province.
And we are this year
deploying electronic health records to each of those.
They'll be bilingual,
ten of them will be in Aboriginal communities,
but that will equip another 600 doctors and nurses
on the front line of healthcare
with the latest tools and technology to help those people.
And perhaps the biggest thing that's happening
right now in the province is we are connecting hospitals
with the community of clinicians around them.
And generically, we call this Hospital Report Manager,
but around the province,
there are many, many different versions.
In Hamilton, there's a system called ClinicalConnect
that connects 28 hospitals with something like 5,000 clinicians.
In Northern Ontario, it's called Physician Office Integration,
and it's in Thunder Bay and it's in Sudbury.
In Ottawa, there's an Ottawa Hospital System,
in London, it's called SPIRE.
There are many, and I'm sure I'm forgetting some.
But the point is that locally,
we are now finding ways of connecting hospitals,
but connecting all the clinicians in the community too.
And I'll talk about how important that is
in the minister's vision
of providing more care in the community,
and more care away from those expensive parts
of our healthcare system.
So...
When I tell this story to people,
the reaction I often get is, "I had no idea.
"I had no idea all these things were happening in Ontario.
Why aren't you out there talking about it?"
And a decision we had to make two years ago
was to focus on delivering results
instead of making promises.
Let's face it: eHealth Ontario has, shall we say,
a legacy problem with its brand.
And we didn't think it was a particularly good idea,
stepping in to start making more promises
and under-delivering.
So instead we put our heads down and said,
"Well, let's produce some results
and let's talk about them."
And you will all know from reading the papers
that it's very difficult to see the word "eHealth"
in a sentence that doesn't also have the word "scandal" in it.
So just to set the record straight,
perhaps I could provide some context
on the time scale involved.
eHealth Ontario was a scandal three years ago.
eHealth Ontario was a turnaround two years ago.
eHealth Ontario last year
began delivering electronic health records,
and this year, we are ramping that up,
and we are attacking on three fronts
in order to improve quality, speed access and reduced cost
to healthcare for the people of Ontario.
How are we doing that?
Well, we're not doing it
as a big government infrastructure IT project.
A lot of people assume that this must be
a big centralized database
that we're in the process of building,
and that somehow there are a number of us
that are busily stapling together
13 million health records.
And if we are successful, there will be a day in 2015
where we can all gather around a low-slung bunker data centre
that has thousands of servers in it.
And there will be a ceremony
where someone will flip the Frankenstein electric switch,
thousands of spindles will whirr to life,
the lights of Ontario will dim momentarily,
and out will fly 13 million
perfect electronic health records
for use by patients and providers alike.
That is not what we're doing.
We don't have to wait until 2015
to start delivering on the results.
What we're doing is we're pushing as much information
into the hands of front-line health providers
as quickly as we can.
The key to this is not building records,
the key to it is connecting clinicians.
When you think about it, all of us have left
little shards of electronic data wherever we've gone.
It's in labs, it's in hospitals, it's in your doctors' files,
it's in specialists' files.
And our job is to get those systems talking to each other.
It's a lot like the internet.
It's a lot like connecting thousands of different systems,
and getting them to talk to each other and exchange information
and represent them in a way that's comprehensible.
And the way we're doing that
is to engage as meaningful as we can
at a local and at a regional level.
What we find around the province is that there...
You probably have a primary care physician in Windsor.
If you get sick, you'll go to a local hospital.
If you get really sick, you'll go to London Health Sciences,
but you're not going to Thunder Bay.
And in those natural referral areas,
tremendous investments have been made
to start to wire together clinicians and hospitals.
Now, just about the dumbest thing that we could do
at eHealth Ontario would be to sit in an ivory tower,
have a brain wave and say,
"Ah, we've decided what
"the common standard system
"for the entire province is going to be.
"So everybody rip out what you've got now,
we've got a big centralized idea we're going to implement."
That is explicitly not what we're doing.
We've spent a tremendous amount of time
going to London and understanding SPIRE,
going to Hamilton and understanding ClinicalConnect,
going to Ottawa and saying, "How do we fund these systems?
"How do we start to raise them to a common standard
"so that they'll be interoperable?
"How do we create the hooks in them
"so that we can feed provincial data into them,
"like images and labs and reports from other clinicians?
And how do we get them all to interconnect in the long term?"
So it's a big, messy process,
but it's a much better problem to solve
than having to try and build something from scratch.
And what it means is that we can deliver results much sooner.
We start to move the dial on quality and cost now,
instead of waiting for 2015.
So let me talk about why this is important,
and do it with a few illustrative examples.
And these are things that I've run across
just in the last couple of weeks
as I've been travelling around the province.
Um, the Health Minister mentioned two weeks ago
that in 2009, 140 hospital--
140,000 hospital readmissions
occurred within 30 days of discharge.
Let's just think about that.
Somebody leaves the hospital and they're back in within a month.
And that happens 140,000 times in a year
in this province.
Now, when we talk to clinicians and say,
"Well, what do we do about that?"
They say, "One of the answers is pretty straightforward,
"and that is, the statistics show
"that if when you leave the hospital,
"you have a visit with your local
"family healthcare provider within a week,
the odds of your readmission drop dramatically."
And if that clinician has the hospital discharge summary,
that describes what happened to you in hospital,
and the drugs you were on and how they changed,
and what the care is, you are back in the community
and you're being properly cared for.
Well, those hospital discharge summaries,
if they're paper, take more than two weeks
to reach the clinician.
So there's no possibility of you going back into the community
and having that meeting with your doctor.
Now that they're electronic,
and we're increasingly making them electronic,
they arrive within minutes of being transcribed.
In January, 165,000 electronic reports
were sent from hospitals out to clinicians in the community.
For people who like to picture these things,
that's a stack of paper 20 stories high.
And they key is not to think about the paper,
it's to think about the clinician time spent
looking for the right kind of information,
so that they can provide care to their patients.
So that's one way that we can really put a dent
in the number of readmissions.
So we're improving quality of care,
we're dramatically reducing cost
and we're speeding access to care.
Another example is the Ontario Lab Information System,
which I mentioned earlier.
I was meeting with an infectious disease specialist last week,
and he was part of our trial in Ottawa
where we were testing this system,
because we needed to make sure it was safe, accurate,
and it was private and secure,
which is very, very important.
Paper records are not private records.
Paper records get mailed to the wrong place,
they get faxed and sit on fax machines.
But with electronic records, we have the opportunity
to really make them quite secure.
And in the case of the lab system,
that's precisely what we're doing.
The data is encrypted, it's stored in encrypted form,
the people who access it use two-factor authentication
when they log in,
we keep an audit trail of who's looked at what when.
So we can keep electronic records far more secure
and private than we ever could with paper records.
But what this clinician was saying is,
"I'm kind of sorry to see this rolled out across the province."
He said that tongue-in-cheek.
"Because during this trial, I've had secret powers.
"Normally, as an infectious disease specialist,
"I see a snapshot of the patient that I'm dealing with.
"I see the last set of lab results.
"And I sit with that patient, I sit with their family,
"and they want to know what's going on.
"And I'm only able to tell them what I've seen.
But with this system--" And he was demonstrating it on-screen.
He said, "Look at what I've got.
"I've got the last lab results,
"I've got lab results from six months ago,
"I've got another set of tests from two years ago,
"and I realise this person's pretty sick.
"They've got comorbidity factors,
"I've got a much better picture of this patient.
"And when I sit with the patient with the family,
"I can tell them a story. I'm not just saying,
"'Well, what these results suggest is this,
"and I'm going to ping pong you off to another specialist.'
"I can say, 'I think we've got an idea what this is,'
"and I can provide a better diagnosis
"and I can provide better care.
"So I felt like I've had secret powers.
"And what's going to happen now is all the doctors in Ontario
are going to have the same secret powers I do."
Now, we're delighted about that.
We're going to be rolling out
the Ontario Lab Information System
as quickly as we can this year.
We have a line-up of hospitals and doctors who want to use it.
The gating factor is privacy and security,
because we're actually using this as an opportunity
to raise the game of a lot of our institutions,
and we're saying, "Okay, you need to be able to handle
"encrypted data screens,
"you need to be able to handle two-factor authentication.
"You need to pass the privacy tests.
When you do, you'll get the data."
And this could be one of the most meaningful things
that we do in the history of eHealth Ontario,
is to have lab results available within minutes
instead of within days or weeks.
The final example I'll give
is also actually based in Ottawa,
and it's probably because that's where I was last week.
The Ottawa Hospital completed the integration
of a local hospital- Hawkesbury General-
so that they are now fully connected.
They're using electronic records that are very similar
so that they can read each other's records,
and they understand what's happening with patients.
And as part of our visit there,
our hosts took us on a tour of the hospital, and said,
"I'm going to show you where we're using electronic records
in various places."
And we were in emergency,
and we were in the part of emergency
where patients were being transferred
from other regional hospitals in the Ottawa area.
And you've all seen the videos of this.
We were in a hallway where there were gurneys,
stretchers stretching down the hallway,
and they all had patients in them,
and they all had family members with them,
and they were all worried.
And they all had a clipboard on their chest
with paper on the clipboard.
The other thing I noticed
was there were EMS staff standing around.
I counted seven or eight EMS staff waiting.
And out in the parking lot,
there were a bunch of ambulances just sitting there.
And I said to him, I said, "Why are they there?"
"Well, they can't leave until we've accepted the patient.
"We have to know who the patient is,
"we have to know what the problem is,
"we have to know who they're going to see in the hospital,
"and it takes us a while to do those transfers.
"Even though that patient has come from
"a hospital ten kilometres away,
"and even though we knew they were coming,
"until we read the paper on their chest, they're John Doe.
"And when we read the paper,
"we can finally start the process of figuring out
"where in the hospital they're going
and who might take care of them."
I said, "Well, okay, an hour ago we announced
"that Hawkesbury General is now connected
"to the Ottawa Hospital.
Are those patients here too?"
"No." "Where are they?"
"Well, they come in a different door."
"Can I go see them?" "No."
"Why not?" "They're upstairs being taken care of."
"We know who they are, we know what the problem is,
"we've assigned them to a doctor,
we've assigned them to a part of the hospital before they leave."
And that, for me, was a very humbling moment,
to think about the difference in quality we provide,
to think of the cost we save,
and to think of the way we speed access
by using electronic records.
So, just in closing,
I'd like to remind you that what we're engaged in here
is not black art, it's not mysterious.
It's been done before.
It's been done by banks, it's been done by airlines,
it's been done by healthcare organizations
in other jurisdictions.
In its scale and complexity, it is massive.
We're not just integrating one bank with a CEO
with a command-and-control management structure.
We have 152 hospital corporations in the province,
generally speaking, with systems that don't talk to each other.
We have thousands of clinicians using electronic records
designed not to be read by other clinicians.
So the task of getting this all knit together is massive,
but we know how to do it, it's been done before.
We are working very closely with the regions.
We're bringing a real sense of humility to this task.
We want to understand what regions want,
what local communities want,
how we can connect into them.
We do not want to reinvent the wheel.
And I'd like to, I guess, one more time,
remind you that three years ago, eHealth Ontario was a scandal,
two years ago, we were a turnaround,
one year ago, we began delivering electronic records,
and this year, we are ramping up our efforts
to improve quality, reduce costs and speed access.
And I believe that if we remain focussed
and passionate about that task,
one day, eHealth Ontario will be a source of pride
for the people of this province. Thank you.
(Applauding)