The high cost of not investing in health care technology

Published in the Vancouver Province, November 18, the Saskatoon StarPhoenix and the Windsor Star, November 20, and the Red Deer Advocate, November 29, 2008

By Rebecca Walberg
Director of Health Policy
Frontier Centre for Public Policy

Rebecca Walbert In the recent election, when the parties discussed their plans for infrastructure investment, the debate revolved around bridges and roads. No mention was made of our crumbling healthcare infrastructure.

While recent research shows that private hospital rooms are the single best way to protect patients from hospital-acquired infection, we have trouble maintaining existing facilities, let alone beginning to renovate outdated buildings or build new ones. Canada also falls below the number of MRI and CT machines per capita that is recommended by the OECD, one factor in the long waits Canadians must endure before receiving these scans.

Unfortunately, our prolonged neglect of health infrastructure can’t be fixed overnight. Even if provincial governments were to find the money today to build up-to-date hospitals, it would be years before the first patient could walk through the door. The same is true if we increase the class sizes in medical schools; while necessary, the added spaces won’t pay dividends for many years, until the doctors are trained.

There is one area, however, in which a relatively low investment today will yield immediate improvements and cost savings, and that is in the appropriate use of information technology in our hospitals.

Ideally, each Canadian should have a complete electronic health record (EHR) which provides doctors and pharmacists with all 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, in fact, the technology already exists here. It just hasn’t been implemented yet.

Governments are planning to bring such record keeping to Canada over time. In the meantime, however, there is a much more affordable technological application which can be adopted and which is long overdue: computerized prescription orders. Doctors’ illegible handwriting has long been the butt 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 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, with related costs of more $16,000, 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 this 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? There has been 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. Hospital stays would be shorter and cheaper with better outcomes and 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. For example, 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 which endanger patients and waste money needlessly.

Keywords: infrastructure investment, infrastructure, healthcare infrastructure, no quick fix, computerized drug ordering, doctor's signatures, health care risks, lack of competition

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