EHRs, Labs and the Toronto Launch

On November 19, a lively group gathered in the back of the Free Times Café for the Toronto book launch of False Positive.  Twenty-five books were sold and, in an unexpected twist, electronic health records, EHRs or sometimes EMRs, dominated the discussion.

The EHR connections with labs were three.  First, the cost of using for-profit information technology companies, like private labs, is hidden from decisions on front line care, yet it represents a significant public expense, probably more for IT than is paid to private labs. Canada’s Infoway, a national non-profit organization funded with five billion dollars of public money to develop a national EHR, spends the vast majority of its money on private sector information technology providers. Similarly, most provinces and territories have EHR programs which include Ontario’s scandal ridden eHealth.  Among its other responsibilities eHealth is tasked with implementing the Ontario Laboratory Information System with its private sector providers.

Second, despite all the money and years of effort, the success at developing integrated EHRs has been, how shall we say, a disappointment.  As with the use of for-profit labs, we have a situation where significant sums of public money are transferred to for-profit firms adding to the cost of the public system, with no extra benefit.  While it has not been studied in-depth, it is a reasonable observation that the contracting to for-profit information technology companies has produced way less benefit than private labs. And for-profit labs have set back the delivery medical laboratory services in Canada.

Finally, a focus of laboratory system modernization in the United Kingdom, Australia, the United States, as well as Canada, has been the development of electronic processes to order tests, track specimens and report results.  Labs results have been a primary focus of the larger project of developing a full patient electronic record. A few places, like Wales and Nova Scotia, have been recognized for success in system wide electronic lab records.  In both these examples all the medical laboratories are public non-profit institutions, though private firms were used to develop the IT infrastructure.

EHRs and medical laboratories both highlight the large sums of money that are spent, largely under the radar of public discussion, on for-profit companies.  This allows governments to claim that they are supporting a public system while enriching private friends and driving up the cost of public health care. It also has removed this for-profit public health care from significant academic scrutiny.  In both cases while much work has been done on the technical aspects of the services little has been done on the impact of its ownership, funding and organization.

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