Nova Scotia’s health system is plagued with problems in governance and administration, long waits, mistakes and poor worker morale.
Many of the problems stem from flawed information-gathering processes within the health system, which make it impossible for the government to properly manage health spending.
One of the most important challenges facing Premier Stephen McNeil and Health Minister Leo Glavine is rationalizing and improving the province’s delivery of health services. This will necessarily mean adopting modern information systems used by all other industries to support the delivery of excellent care.
Improving the quality of information available to patients will help enable them to make sound choices about their own health. Better information will also promote accountability by giving voters information they need to evaluate health system performance and make informed political choices.
By the next election, about four years from now, voters should expect to have answers to at least the following six questions:
1. Does the Department of Health have information to track the results of care?
Some treatments help people, some treatments harm people, and some are a waste of time and money. Tracking health-care results using techniques that are available in any retail store will help patients avoid wasteful or harmful treatments, and help government spend money on worthy tests and treatments.
2. Does the Department of Health have information systems in place to identify everyone waiting for care, why they are waiting and the consequences of a prolonged wait?
Every industry, except health care, knows who is on a waiting list for service, why they must wait, and the consequences of waiting. The information is necessary to know how to allocate scare human and financial resources.
3. Does the Department of Health have information showing administrators where to assign the limited number of health workers?
The recent controversy between the provincial government and the Capital Health nurses’ union occurred because workloads overwhelm some nurses, insufficient workloads bore other nurses, and an overload of administrative work prevents some nurses from meeting what they regard as their clinical role. Hospitals must have timely, accurate information to understand which wards have patients with unexpectedly high levels of sickness and dysfunction, and consequently too few nurses, and which wards have fewer sick patients.
4. Are mistakes increasing or decreasing?
Ten years ago, the Canadian Medical Association Journal published an important study showing that Canadian hospitals have unacceptably high rates of preventable mistakes leading to preventable death, disability and discomfort. Capital Health in Halifax participated in the study. Today, Capital Health will not tell us if the rate of preventable mistakes is increasing, decreasing, or staying the same, and no Nova Scotia provincial government has ever bothered to ask.
5. Do people get the information they need to participate in their own care and prevent mistakes?
Patients are the most important, motivated, and least expensive members of the health-care team. Canadians die when important results are lost or mishandled. In Nova Scotia, unlike in other jurisdictions, most patients can neither get the results of lab tests directly from the laboratory nor can they access them electronically. Instead, they must meet face-to-face with their doctor.
The Nova Scotia Co-operative Council has devoted millions of dollars to projects designed to support patient participation in their own care. The Department of Health was a barrier because previous governments did not insist that laboratories provide information in a standardized way. Patients could not access their own health information. The co-operative council remains an important participant in health care. Government can help Nova Scotians by insisting that laboratories report individual results, using standard protocols, so that the laboratories, family doctors, and interested groups like the co-op council can provide patients with all of the information they need to participate in their own health care.
6. Do Nova Scotians have full-time access to personalized health information or must they rely on an impersonal 811 service?
Previous governments contracted with McKesson to provide an 811 telephone service, so Nova Scotians could get advice from a nurse who didn’t know them rather than calling their own family doctor. The average cost for a telephone call to 811 is far more than the amount government pays a family doctor to see someone in person. A better model will enable people to call their own doctor’s office to get personalized advice whenever they need it.
Our new provincial government inherited an underperforming health-care system partly because the Department of Health is missing the information necessary for management. Over the next four years, the new provincial government must take advantage of advances in information technology to build a more sophisticated health department to ensure that patients, administrators and voters have the information they need to make the best possible choices.
David Zitner is a family doctor, past director of Medical Informatics at Dalhousie Medical School and the senior fellow in health-care policy for the Atlantic Institute for Market
*This piece appeared in the opinion section of the Chronicle Herald