Infrastructure investment featured in the election platforms of both the Liberals and the Conservatives, which reflects crumbling roads and overwhelmed sewer systems across the country. Our healthcare infrastructure also needs attention. Recent research shows that private hospital rooms are the single best way to protect patients from hospital acquired infection, for example, but we have trouble maintaining existing facilities and can’t begin to renovate outdated buildings or build new hospitals. With respect to pricey diagnostic equipment, Canada falls below the OECD mean numbers per capita of MRI and CT machines, one factor in long waits for these scans.
Prolonged neglect of our health infrastructure can’t be fixed overnight. Even if provincial governments could find the money in their budgets to build up-to-date hospitals, years would pass before the first patient would walk through the door. Increasing the number of spaces in medical schools, while also necessary, won’t pay dividends immediately, since it takes many years to train a doctor. There is, however, one area in which relatively low investments will yield immediate improvements and cost savings, and that is in the appropriate use of information technology in our hospitals.
In an ideal world, all Canadians would have a complete electronic health record (EHR) which would provide doctors and pharmacists with the information they need to make treatment as effective and safe as possible. Such electronic records are increasingly common in Europe and the US, and the technology already exists here, although it hasn’t been implemented.
Governments are planning to bring such record keeping to Canada over time. but in the meantime, there is a much more affordable technological application, the adoption of which in Canada is long overdue: computerized prescription orders. Doctors’ illegible handwriting has long been the stuff of jokes, but a major study of medical errors describes the pen and prescription pad as a “deadly vehicle for medication errors.” Fifty years ago, only a few hundred drugs were on the market; now doctors prescribe from a list of over 17 000 drugs. If a prescription is hard to read, it is all too easy for patients to be given the wrong drug, or the right drug at the wrong dose. The consequences of such an error are costly and sometimes deadly.
Such mistakes occur in between two-and seven percent of all hospitalizations, and one in ten results in serious injury or death. Patients who suffer no lasting damage from a medication related error still have hospital stays that average a week longer, and cost $16,000 more, than other patients. Tolerating such a high rate of medication error is bad medicine and bad business.
Computerized drug ordering is a solution with a proven track record. When physicians order drugs electronically, either from a handheld device or a computer terminal, error caused by handwriting is removed from the equation entirely. Increasingly, hospitals that use that method have integrated software that helps doctors to confirm whether they’ve selected the appropriate course of therapy, and flags unusual dose levels or schedules. The results include a reduction of up to 95% in medication error, when the wrong drug is prescribed, and 80% in delivery error, when a drug is given at the wrong dose or frequency.
Converting all Canadian hospitals to such a system would cost roughly $3 billion, after which yearly savings would be $1.2 billion. Other benefits of implementing computerized ordering include a better use of healthcare resources, as hospital stays would be shorter and cheaper, and of course better outcomes; fewer patients would be injured by medication errors. Very few upgrades pay for themselves so quickly, or yield such dramatic improvements.
Why, then, has Canada not incorporated this technology when it is increasingly common in the UK, US and Australia? The absence of external pressure to improve is certainly a major factor. If hospitals had to stay competitive, they would quickly adopt technology that would save them money, and if our healthcare system were more accountable, pressure to improve outcomes and reduce error would drive improvement.
Changing Canadian healthcare to make it more responsive to the needs of patients and providers will take a lot of time and effort. The decision to use computerized order entries will be made at the hospital or regional authority level, but provincial governments can provide incentives, for instance by pairing a subsidy for making the transition to computerized ordering with a reduction in healthcare transfers for regions that fail to take action. The Blue Cross Blue Shield network of insurers, which covers almost one third of Americans, has announced that it will assess penalties against hospitals that still use the prescription pad beginning in 2012. Canada should implement something similar. We shouldn’t keep funding hospitals that endanger patients and waste money needlessly.