NORTHWEST TERRITORIES
The process of creating, maintaining and expanding electronic information systems is a never-ending balancing act between providing patients with the best care possible and protecting patient privacy, said physician Dr. Ewan Affleck.
Affleck initiated the first electronic medical records system in the territory in Yellowknife in 2005.
There are several different systems that capture health and social services information electronically in the NWT, said Michele Herriot, chief information officer at the Department of Health and Social Services.
Two Electronic Medical Records Systems (EMR) - one in Yellowknife and one in Hay River - replaced paper-based medical records.
A territory-wide Electronic Health Records (EHR) system provides medical practitioners with read-only summaries of key patient information and past medical tests.
Two territory-wide systems allow for the electronic sharing of medical scans and lab tests.
"With each of the territory-wide systems, we're very careful about who we give access to and what roles people have," Herriot said. "There is always the potential that somebody will abuse their access, but you could have that in the paper (records) world as well."
For example, the EHR system is audited weekly for inappropriate access to patient information and the department is increasing privacy training for all staff who use these systems, she said.
The next system the department is working on is a territory-wide EMR system, which will make health care in the territory unique in Canada because it will become the first jurisdiction to organize health records in a single, integrated system, she said.
"We've actually become the poster child with some of these systems for the rest of Canada because, even though we're small, we're able to run faster than places in the south," said Herriot. "The dream is eventually we will be able to hook up to the rest of Canada, but we need to get our own house in order first."
Herriot said expanding electronic health in the NWT is important because the technology saves lives.
In Canada, there are about 25,000 deaths every year due to a lack of the right medical information at the right time, she said.
A Digital Imaging and Picture Archiving Communication System (DI/PACS), which allows medical practitioners to share digital scans such as X-rays, was started in March 2009 in the territory's regional centres and was rolled out to all community health centres that do diagnostic imaging in 2010.
Before the PACS system was in place, X-ray technicians developed images chemically and mailed them to specialists in the south for analysis - a practice that took up to two weeks for results. With the PACS system, that time has been reduced to as little as 35 minutes.
This technology made all the difference to Brendan Seaton, an Ontario tourist who was travelling on the Dempster Highway to Inuvik in July 2010 when his motorcycle hit a patch of soft gravel about 70 km out of Inuvik and he crashed and broke his ankle.
He was quickly transported to the Inuvik hospital, X-rayed, and those scans were sent to an orthopedic surgeon in Yellowknife, who discussed his condition with the nursing staff in Inuvik, who then stabilized his leg. The break was serious enough for Seaton to be medevaced to Stanton Territorial Hospital for surgery - a diagnosis that was determined by the surgeon because he was able to see the X-ray taken in Inuvik.
"Excellent people, excellent facilities and excellent technologies. You have a lot to be proud of," wrote Seaton in a letter to the editor published in Yellowknifer on July 19, 2010.
More recently, the life of a head trauma victim in a Northern community was saved by technology. Herriot could not give exact details for privacy reasons. However, when staff at Stanton reviewed the patient's information, they realized the injuries were beyond what they could handle and informed the medevac plane to fly straight to Edmonton.
"What we found out later was, if they had touched down in Yellowknife and taken the time to examine the patient physically, instead of electronically, they would have lost too much time and the patient would have died," she said. "So, to me the benefits do outweigh the risks."
There are risks with any information-sharing system, as territorial privacy commissioner Elaine Keenan Bengts highlighted in a scathing annual report stating that Yellowknife's EMR system makes too much sensitive information accessible to the roughly 150 workers at Yellowknife's two primary care clinics.
The fundamental problem with electronic-health systems in the NWT is there is no legislative framework surrounding how health information should be shared, leaving Keenan Bengts and those who work on the systems to rely on the more generic Information and Protection of Privacy Act, said Affleck.
The GNWT is currently working on health information legislation, he said, but creating new laws takes time and in the meantime the lack of rules surrounding the sharing of patient information makes creating and managing important electronic medical systems more challenging than it needs to be.
"A miner needs ground to dig, a tailor needs fabric, and we need information to provide our services," said Affleck.
