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Last week, I wrote about the slow pace of adoption of electronic health records by Ontario’s private physicians.

A colleague pointed out a recent article in the NY Times about Walmart marketing a digital health records system through its Sam’s Club division, which recently announced its exit from Canada.

The Walmart system is bundling Dell’s computers with an application from eClinicalWorks.

will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year

The Times story says that health technology suppliers have found it costly to sell to small physician offices because even though they represent a large market, they are scattered. Enter Sam’s Club.

Yesterday, the Toronto Star printed an article recognizing the 10th anniversary of Ontario’s Electronic Child Health Network (eCHN).

I read the story and wondered if we should be celebrating or mourning eCHN’s achievements over the past 10 years.

The article says:

Last week, eCHN celebrated its 10th anniversary. It is now hailed as the model for a comprehensive provincial system of electronic health records. It covers every region, encompasses 100 hospitals and includes the medical histories of 1.2 million children.
…
The database is still a work in progress. Children without hospital records aren’t included. Most physicians in private practice aren’t part of it. And 50 or so hospitals have yet to be connected.

So, after 10 years, most physicians in private practice aren’t connected, but isn’t that where most children’s medical records are located? Aren’t private physicians providing the bulk of our kids’ primary care?

As a result, the eCHN can’t have the complete medical histories of 1.2M children, it has partial records. As the article says:

Access to up-to-date information eliminates guesswork, reduces delays in treatment and lowers the risk of adverse drug reactions. It allows all the doctors, nurses and therapists working on a child’s case to see the big picture.

Without the private physicians records, how can we avoid either delays or guesswork. For a project 10 years in the works, has eCHN gone far enough?

The results from eCHN proves that the project is doable, but it seems to me that we need to get it done.

An article about Terry Matthews in the Ottawa Business Journal celebrates the energy of top rated new grads. A comment in that article observes that 10 years ago, the founders of Google had nothing but fire in their belly.

I’m not suggesting that eCHN should be held to such a Google-like standard – no project on the planet could- but with billions of dollars per year in Ontario health care spending, should we not be demanding a faster pace of modernization for the system?

The Federal Budget included funds to accelerate electronic health records [which we observed should be a positive for TELUS Health Solutions]. Provincial governments need to invest as well in this kind of keyboard-ready infrastructure. This is a stimulus plan that is almost certain to produce a positive ROI.

Our family has had a number of interactions with the health care systems in Ontario and Quebec over the past month. The quality of care has generally been great, but if phone companies were run like these hospitals, they would be out of business.

Paper records. New ID cards issued each time you go. Long line-ups at each stage. Wait times to even get scheduled. Digital records that can’t be sent electronically because no secure network exists.

I’m not talking about remote areas of the provinces. This is the experience we put up with in major hospitals in Toronto and Montreal.

In some ways, the situation almost reminds me of phone companies, in those days before competition. Except that we had a regulator that made sure that customer service standards were more tolerable.

Talk about an industry that is long overdue for efficiency improvements. What can the telecom industry do to help deliver better health care service at lower cost?

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I had an interesting discussion this afternoon with some family members about the challenges of living within our celebrated Canadian health care system.

It seems that conversations about privatizing portions of the system always seem to polarize people. The main concerns are creation of two tiers of health care and taking resources away from the vulnerable. The assumption is always that the public side will lose the best providers.

Which seems to me to be an acknowledgement that we are not properly compensating the health care providers. But this isn’t a blog about health care; how, Professor does this connect to Telecom Trends?

I’m glad you asked. It seems to me that discussions about Network Neutrality have some elements in common with the debates about universal health care. People who are concerned about the emergence of a multi-tier Internet are ignoring the fact that business already has created just that. Not satisfied with the vagaries of public internet quality of service, enterprise IP networks are often built on private or managed networks. Much like the wealthy and our politicians seem to be able to jump the queue for MRIs and elective surgery.

Complaints about evil, profit minded ‘broadband monopolists‘ (as Russell Shaw calls them) sound like the way the Toronto Star writes about those evil American firms offering MRIs and CT scans to Canadians. How dare they want to offer a service that people are willing to pay for at a price that makes sense for the investors! Quick, we need legislation to protect these feeble minded citizens who don’t know how to make decisions for themselves.

At the same time, I agree that there is much to be said for the creativity and breadth of applications that have been generated using the current model of open internet – just as there is much to be said for the Canadian principle that says you don’t lose your life savings just because you got sick.

Is it not possible to have both public and private models co-exist? When mediocrity [and I say that in the nicest possible way!] is good enough, the current model works just fine. But if an application, or an application provider, needs something more, what is wrong with them paying to get it?

It would help if someone can explain the wide-open view without resorting to Communist style language that I thought died out when the Berlin Wall fell. Let’s have an open discussion of the issues without resorting to calling telcos and cablecos ‘broadband monopolists’. If Bay Street or Wall Street really believed that there is a monopoly for broadband access, BCE wouldn’t still be hovering below $30.

The ITU’s Broadband Commission released a report, “The State of Broadband Advocacy Targets” [pdf, 6.1MB] as part of its State of Broadband 2025 report series. The report recognizes that “communication services providers and operators have enabled, and helped deliver, years of reasonably consistent economic growth across different countries and economies.”

as gaps in access narrow, the digital divide is taking on new forms. Digital technologies are expanding in scope, scale and influence. Policy-making and regulation have moved on from questions of basic access to telecommunications and Internet to recognize different types of digital divides, such as age and/or gender digital divides, and their implications for access to education, healthcare, e-government services, employment opportunities and participation in the digital economy.

As I wrote a few weeks ago, the Broadband Commission report found strong progress in affordability, with targets having been achieved at the global level. As a result, policy-making is evolving to include new and emerging topics such as digital transformation and AI.

The State of Broadband Advocacy Targets report is intended to inform policy-makers on progress towards the Broadband Commission’s goals. It emphasizes a need to leverage the benefits of digital technologies, mitigating potential risks, while aspiring for equitable access to digital opportunities.

The report also presents an overview of broad industry trends, as well as case studies for the advocacy targets to illustrate how broad trends are playing out in practice. It briefly looks at how different initiatives, policies, platforms and programmes help make a difference in people’s lives through broadband connectivity and services.

The advocacy targets:

• Advocacy Target 1: Make broadband policy universal
• Advocacy Target 2: Make broadband more affordable
• Advocacy Target 3: Get everyone online
• Advocacy Target 4: Promote Digital skills development
• Advocacy Target 5: Increase use of digital financial services
• Advocacy Target 6: Get MSMEs online
• Advocacy Target 7: Bridge the gender digital divide

How is Canadian broadband policy evolving to recognize advances made in Canada’s competitive landscape?