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Dr. Don Beach views a patient's digital record using the Department of Health and Social Services' Digital Imaging and Picture Archiving Communication System (DI/PACS). Electronic health information systems are desperately needed in the health-care field to improve patient care and lower health-care costs, experts agree. However, this must be done in balance with maintaining patient privacy, says Yellowknife physician Dr. Ewan Affleck. - photo courtesy of the Department of Health and Social Services

SOMBA K'E/YELLOWKNIFE
The process of creating, maintaining and expanding electronic medical information systems is a never-ending balancing act between providing patients with the best care possible and protecting patient privacy, says Yellowknife physician Dr. Ewan Affleck, who initiated the first electronic medical records system in the territory in Yellowknife back in 2005.

Types of electronic medical records systems EMR ­ Electronic medical records, which replaces paper-based medical records and logs who is accessing the information. Currently used in Yellowknife and Hay River, with plans to expand across the territory. DI/PACS ­ Digital Imaging and Picture Archiving Communication System, which shares and stores X-rays and other diagnostic imaging. LIR ­ Lab Information System, used by the territory's three labs in Yellowknife, Fort Smith and Hay River. EHR ­ Electronic health records system is territory-wide and provides consolidated information from all other records systems, but is a view-only system. Source: Department of Health and Social Services System audited weekly: GNWT Aside from electronic medical records systems in Yellowknife and Hay River and the DI/PACS system, there are many other systems that capture health and social services information electronically, said Michele Herriot, chief information officer for the Department of Health and Social Services. "With each of the territory-wide systems, we're very careful about who we give access to and what roles people have," she said. "There is always the potential that somebody will abuse their access, but you could have that in the paper (records) world as well," she said. There is also a lab information system between the territory's three labs in Yellowknife, Fort Smith and Hay River, and an Electronic Health Records (EHR) system that consolidates reports stored in separate systems in a central, web-based repository. The main difference between an EMR system and an EHR system is that information in an EMR file can be altered, whereas the EMR system is view-only, she said. The EHR system is audited weekly for inappropriate access to patient information, said Herriot, and the department is increasing privacy training for all staff who use these systems. 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."

"It's a very delicate balance," he said. "On one level, you risk hurting people ­ or not providing them effective care, which will damage their health ­ and on the other side you risk not ensuring that their information is private."

The GNWT's digital medical records system came under fire earlier this year after privacy and information commissioner Elaine Keenan Bengst issued a report to the legislative assembly saying too many health-care workers had access to files in Yellowknife's two primary health-care centres.

The fundamental problem with the system in the NWT, however, is that there is no legislative framework surrounding how health information should be shared, leaving Keenan Bengts and those who work with the system to rely on the more generic Information and Protection of Privacy Act, said Affleck.

"We have to be innovative in health and if we aren't we risk losing our health-care system," said Affleck.

"You have to have your head in the sand if you don't understand that. As health-care costs are rising and populations are getting older and the health-care budgets of every province and territory are increasing, there is warning after warning about this not being sustainable."

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.

Michele Herriot, chief information officer for the Department of Health and Social Services, said the reason why the department is continuing to expand its existing electronic medical information system outside of Yellowknife is simple: it saves lives.

In Canada, there are about 25,000 deaths every year because proper medical information was not available, she said.

Since the department began turning to digital technology to share health information, many lives have been saved in the Northwest Territories, said Herriot.

She points to the Digital Imaging and Picture Archiving Communication System (DI/PACS) which allows medical practitioners to share digital scans like X-rays. It 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 down south for analysis,
a practice that took up to two weeks. With the PACS system, that time has been reduced to as little as 35 minutes.

This technology made all the difference for one Ontario tourist who was travelling on the Dempster Highway to Inuvik in July 2010 when he crashed and broke his ankle 70 km outside of Inuvik.

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 the man to be medevaced to Stanton Territorial Hospital for surgery ­ a requirment that was determined by the surgeon because he was able to see the X-ray taken in Inuvik.

More recently, the life of a head trauma victim in a Northern community was saved by new technology. When staff at Stanton reviewed the patient's information, they realized the injuries were beyond what they could handle and informed the medevac pilot to fly straight to Edmonton, said Herriot.

"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."

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