Wednesday, 10 June 2015

The Cost of Health IT Sovereignty

Whenever I tell my friends I’m an eHealth consultant, I get the same two questions:
  1. Why don’t we just take someone else’s eHealth system that works and run it here?
  2. If finance, supply chains, and practically every other industry can move data around easily, why can’t healthcare do it?
Canadians spend far more on their healthcare IT software than they should.  A big reason for this is our provinces’ insistence to go it alone on all their IT projects: building their own networks, software systems, and all the certification work that goes into approving that infrastructure.

Why do our provinces feel compelled to do everything on their own?  Is it a sense of provincial pride?  “We Albertans know better than Manitobans how to run a healthcare system.”  The Bureaucratic Mandate?  “My province needs its own independent Standards, Architecture, Privacy and Security healthcare offices”.  Asserting sovereignty can feel politically rewarding, but it introduces two unnecessary costs to expanding a successful eHealth solution from one Province into another:
  1. Re-certifying for Privacy and Security.
  2. Re-tooling for interoperability.
These costs could be avoided if the provinces set aside their differences and agreed to relinquish their sovereignty for certifying interoperability, privacy and security of healthcare solutions to a federal agency.

Canada Health Infoway (CHI) has been eager to take on this role and will certify that a healthcare system meets national interoperability, privacy, and security standards.  As a vendor, I welcome the opportunity to certify my system once with a national agency and be done with it.  However, before I sign up for this, I first need to be damn sure this certification will be honoured by most of the provinces.  It’s currently not mandated by any.

Without the explicit agreement of the provinces to relinquish this responsibility to CHI, CHI’s certification is meaningless.  There are two things CHI could do to fix this:
  1. Co-operation.  Persuade provinces to relinquish responsibility for this certification work to Canada Health Infoway.  Vendors want it (see the published ITAC Health position).  Citizens want it (because they want eHealth systems sooner, at a lower cost.)  All that remains is persuading provincial governments to do the right thing.
  2. Incentive.  Secure billions of dollars of funding from the Federal Government and provide it to organizations only if they purchase certified systems.  This is the approach the U.S. took with its Centers for Medicare & Medicaid Services Meaningful Use Incentive program.
If Canada doesn’t figure this out, our Health IT sector will eventually just get replaced by American solutions.  We still have time to get our act together, but we will need to act fast.  Solving this should be a top priority for Infoway.

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