Creating an unnecessary barrier between doctors and patients

A convoluted – and doomed – communication portal in Nova Scotia has failed the health care system and its users on both sides By David Zitner Senior Health Policy Fellow Atlantic Institute for Market Studies Most businesses encourage clients to electronically access their own information because consumers value the efficiency and convenience of electronic access.   Unfortunately, the Nova Scotia Department of Health (DOH) has a different idea. It has been a successful barrier preventing most Nova Scotians from retrieving and using their own health information.   Few Nova Scotians have access to their own health records or timely, unimpeded, access to the results of recent tests. Most Nova Scotians can’t communicate with doctors by phone or email.   The DOH claims it wants to simplify care by encouraging people to participate in their own care and have access to their own information. However, only a select few Nova Scotians, privileged by DOH policies, can call and speak to doctors over the telephone and can access their health information.   The Department of Health unashamedly reports that after eight years of effort, and at huge financial expense, only a tiny and select group of 30,000 patients cared for by 300 doctors have routine access to a health information portal. The remaining 97 per cent of Nova Scotians are in the second tier for health care, without access to a personal health information portal or the ability to speak over the phone with their doctors (if they have one).   MyHealthNS, using McKesson’s Relay Health, has been an ongoing effort by the Nova Scotia Department of Health to give all Nova Scotians access to some of their health information. Unfortunately, it made a simple goal complicated and became a barrier to Nova Scotia innovation. Not surprisingly McKesson Canada is withdrawing from this failing venture.   In the interest of putting most Nova Scotians at a similar disadvantage, the Department of Health doesn’t allow anyone, including doctors and nurses, to retrieve their laboratory results or other health information from any system other than the cumbersome and doomed Relay Health system approved by the DOH.   Nevertheless, despite inadequate compensation for electronic communication, a few doctors continue to encourage and support patients who want to use ordinary email for their communications.   In the normal world, forwarding an email is easy. The initial recipient of an email report merely forwards the information to another recipient. In the case of health information, the doctor can forward laboratory reports or advice using any email system acceptable to the doctor and patient.   Many patients prefer to take the risk of insecure communication using common email systems to gain safer and more efficient care. They prefer their usual email systems partly because health department systems regularly report privacy breaches.   Sadly, the Relay Health project interfered with existing projects, including ones by the Cooperative Council, that were designed to accomplish similar goals and at no cost to government or patients.   One electronic health record vendor whose product was used by many Nova Scotia physicians reported that the Department of Health wouldn’t allow it to put patients’ email addresses in doctors’ patient record systems. The DOH insisted that clinicians only provide patients with access through the cumbersome Relay Health system.   Rather than taking five or 10 seconds to forward a report with a brief comment, the Department of Health demanded that doctors take substantially more time to use Relay Health.   Every year, some people are harmed, including dying, because a lab report was ignored, mishandled or lost. When patients have access to their own laboratory reports, they have the power to be active participants in their care and prevent the consequences of lost reports.   There are no rational reasons for the Nova Scotia Department of Health to continue to act as a barrier to easy communication between doctors and their patients.   Dr. David Zitner, a retired family physician, was the founding director of the graduate program in Health Informatics at Dalhousie University and is Atlantic Institute for Market Studies (AIMS) senior health policy fellow.

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