Good enough in healthcare isn’t good enough, or is it? Are we getting exactly what we deserve from “the system” today? Do we have a right to expect something more?
Yesterday, I was one of three panelists in a webinar titled “Digitizing Canada’s Healthcare System”. The webcast was the first in a series of debates to “engage all stakeholders in open, unfettered discussions about the current and future direction of healthcare IT in Canada”. The other panelists were Steven Lewis and Stephen Duckett, PhD. Mr. Lewis is a health policy and research consultant and adjunct professor of health policy at the University of Calgary and Simon Fraser University. Dr. Duckett is an economist and professor in the School of Public Health, University of Alberta. He is also past president and CEO of Alberta Health Services, Canada’s largest healthcare provider. The panel was slated to include Tom Bowden, CEO and co-founder of HealthLink Ltd., which has developed a range of communications systems and services that are used by 9,000 New Zealand and Australian health-sector organizations, Due to technical problems, Mr. Bowden was unable to join us. Simon Hally, editor/publisher and Canadian healthcare manager for Rogers Healthcare Group served as the moderator for our panel.
Our charge in this first debate was to set the stage for future programs. We discussed the most important opportunities and challenges surrounding healthcare IT from a system point of view. We also examined what needs to be done to reach the goal of digitizing Canada’s healthcare system successfully, what we have learned from the experience to date, what is working well, and what is not. I was delighted to have been invited to participate on the panel and share my thoughts based on what I see happening around the world. It was nice of organizers to include me since I’m American, not Canadian. I was also the only physician on the panel. I made it very clear that it would be presumptuous for me to think I know better than Canadians on how to fix their healthcare system. That is especially true considering the many inadequacies of the American healthcare system which I understand a whole lot better. I practiced medicine in the Seattle area for 20 years before joining Microsoft.
I wouldn’t say that anything revolutionary came up in our panel discussion. We highlighted the usual themes about standards and requirements for EMR interoperability, the need for greater leadership at all levels, the importance of business and regulatory models to support the adoption of health ICT and stimulate e-Health solutions, etc. But towards the end of the program we touched on something that I really hadn’t given much thought to before this.
A question came up about consumer engagement. Specifically, did we think that consumers and patients are playing an important role in pressuring the health industry to go fully digital and provide more e-Health services? I answered that yes, I am seeing evidence of this particularly among younger consumers who already embrace technology and have certain expectations about the kinds of services they should be getting from any industry, not just healthcare. For instance, my twenty-something daughter has told me more than once that she and her friends would never establish a relationship with a physician who didn’t use electronic medical records, allow access to on-line test results, use e-prescribing, or permit on-line scheduling of appointments. But then, one of the other panelists made what I think is an important observation. Canadians, he said, already have rather low expectations about what to expect from their healthcare system. They have been conditioned by years of “good enough”. They often must endure long wait times for services. Some may have experienced a great deal of difficulty even finding a physician to care for them. They really can’t be too fussy about things like whether or not the doctor uses electronic records. They have become accustomed to accepting whatever they can get, because anything is better than nothing.
I don’t bring this up to disparage the Canadian system. The same would be true for many consumers in America as well as for those in other countries of the world. Healthcare behaves differently than other industries. There is almost always a disconnect between those who get services and those who pay for services. Doctors are generally incented to provide sickness care, not wellness care. Often the more doctors do, the more procedures they perform, the more money they make. And patients too must share part of the blame. So long as people think they can keep on eating too much, smoking, not exercising, using drugs, drinking too much alcohol, and doing whatever unhealthy things they want to do and that somehow when something bad happens, the doctor will fix it and society will pay for it……then we will have the systems we have. We will get what we will get (and what insurance or society is willing to pay for). No one will be accountable. And no one will demand something more. Or will they? What do you think?
Bill Crounse, MD Senior Director, Worldwide Health Microsoft