JIM VIBERT: Is OPOR the best health investment for Nova Scotia?

Forget, just for a moment, the unanswered questions surrounding the search for an IT partner to build the province’s digital health platform – called One Person, One Record (OPOR) – and ask yourself if OPOR is the right investment in Nova Scotia’s health system right now.

The price tag for OPOR is a moving target, but industry insiders agree that it will run into the hundreds of millions of dollars, with some estimates topping out at closer to $1 billion, although the spending would be spread over several years. Nova Scotia’s total annual health budget is about $4.7 billion.

Most Nova Scotians would agree that access is the biggest problem in the province’s health system. Whether it’s access to a family doctor, access to a specialist, timely access to emergency care or to a myriad of other services, most Nova Scotians report that the care they receive is top notch, but the problem, too often and for too many, is the long wait to access that care.

The experience elsewhere suggests that access to health services doesn’t improve with electronic health records (EHR). In fact, they impose added burdens on doctors and have the opposite effect.

OPOR is expected to provide every Nova Scotian with a digital health record that would be available to health-care providers wherever and whenever needed. According to the Health Department’s 2019 business plan the procurement process for OPOR will be completed and the project will be initiated this year. The lucrative contract to supply the technology could be awarded and announced any day.

Electronic health records are all the rage and have been for almost two decades. They’re in use in more than 90 per cent of hospitals in the United States, and Canada is moving in the same direction. It only stands to reason that in the digital age, EHRs should be a vast improvement over paper records and charts. At least, that’s the conventional wisdom.

But EHRs are being blamed for an increase in physician burnout and a decrease in job satisfaction among doctors across the U.S. The repetitious box-checking and searching through reams of data are increasing what U.S. researchers call the “cognitive burden” that’s wearing out doctors and driving increasing numbers into early retirement.

That’s an outcome that would be disastrous in Nova Scotia.

A Harvard School of Public Health study in 2018 called physician burnout a public health crisis, and one of the study’s authors apportioned a fair amount of the blame on the growth of digital health records that force doctors to spend more time with the technology than with their patients.

EHRs change the doctor-patient relationship, with the doc tending to make more eye contact with the computer screen than with the patient. Patients don’t like it, and for doctors it is downright demoralizing.

In Nova Scotia, where access to medical professionals is a pressing problem, decision-makers ought to think long and hard before layering on technology that, in other jurisdictions, has driven practitioners to despair and retirement.

Before embarking on the OPOR venture, the province and the health bureaucracies should satisfy themselves – and the rest of us – that it won’t create those kinds of problems here.

But if the past is any indication, don’t expect the government to be transparent or forthcoming about OPOR.

Numerous irregularities in the process to determine the vendor to supply the OPOR technology have been reported by Herald editor Paul Schneidereit, but neither the provincial government nor the Nova Scotia Health Authority (NSHA) has been willing to answer questions directly related to those irregularities.

Why, for example, did the two vendors who became the two finalists for the massive contract have preferential access to key NSHA officials, while another potential vendor was told the authority wouldn’t be meeting vendors? Or, why didn’t the panel that selected the finalists – Cerner and Allscripts – check references before winnowing the field to those two? References accounted for 20 per cent of the score that determined the shortlist. Why did the NSHA scrub its website to remove evidence of prior contact with the finalists? Why didn’t the panel consider the proponents’ performance in other jurisdictions? There are more questions, but no answers.

Schneidereit reported last week that the incoming CEO of the NSHA, Brendan Carr was CEO at Island Health in British Columbia during a problem-plagued EHR rollout there.

Cerner, one of the finalists for OPOR, was the technical partner on that project. And yes, lessons learned from mistakes in B.C. could conceivably benefit Nova Scotia.

But before the province leaps into a massive investment in technology, Nova Scotians need to hear how it will improve the delivery of health care in the province, and specifically, if and how it will improve access to medical services.

In the U.S., 70 per cent of doctors say, in their opinion, the EHRs they use are not worth the money.

Before Nova Scotia dumps hundreds of millions of dollars into OPOR, Nova Scotians deserve to hear why it is the best possible use of those dollars in the province’s over-burdened, under-resourced health system.

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